Miracle-dz/UniFAR-FTUs huggingface dataset:
Primary closure versus delayed closure for non bite traumatic wounds within 24 hours post injury.

BACKGROUND Acute traumatic wounds are one of the common reasons why people present to the emergency department. Primary closure has traditionally been reserved for traumatic wounds presenting within six hours of injury and considered 'clean' by the attending surgeon, with the rest undergoing delayed primary closure as a means of controlling wound infection. Primary closure has the potential benefit of rapid wound healing but poses the potential threat of increased wound infection. There is currently no evidence to guide clinical decision-making on the best timing for closure of traumatic wounds. OBJECTIVES To determine the effect on time to healing of primary closure versus delayed closure for non bite traumatic wounds presenting within 24 hours post injury. To explore the adverse effects of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours post injury. SEARCH STRATEGY We searched the Cochrane Wounds Group Specialised Register (searched 14 July 2011); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (1950 to July Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 13, 2011); Ovid EMBASE (1980 to 2011 Week 27); and EBSCO CINAHL (1982 to 14 July 2011). There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials comparing primary closure with delayed closure of non bite traumatic wounds. DATA COLLECTION AND ANALYSIS Two review authors independently evaluated the results of the searches against the inclusion criteria. No studies met the inclusion criteria for this review. MAIN RESULTS Since no studies met the inclusion criteria, neither a meta-analysis nor a narrative description of studies was possible. AUTHORS' CONCLUSIONS There is currently no systematic evidence to guide clinical decision-making regarding the timing for closure of traumatic wounds. There is a need for robust research to investigate the effect of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours of injury.
Public Health Administration: Principles for Population-Based Management

New Edition Available 8/15/2013 This shorter, more user-friendly edition of Public Health Administration: Principles for Population-Based Management will provide your students with a comprehensive understanding of the principles, practices, and skills essential to successful public health administration. The second edition has been thoroughly revised and includes new information on the Healthy People 2010 objectives as well as two new chapters on bioterrorism and emergency preparedness; and public health systems research. The chapter on public health law has been thoroughly revised by the nation's top public health law expert. Other updates include coverage of the most recent reports issued by the Institute of Medicine as well as analysis on the relationships between public health and the healthcare services with a particular focus on the uninsured.
Case finding for chronic obstructive pulmonary disease (COPD) in primary care : finding the optimal approach

Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality but widely underdiagnosed. This thesis explores methods to improve case finding for COPD in primary care. It includes two systematic reviews- the first evaluated the diagnostic accuracy of screening tests and showed that handheld flow meters are more accurate than the COPD Diagnostic Questionnaire. The second evaluated the comparative effectiveness of different case finding strategies and found that inviting symptomatic ever smokers for a screening assessment may be more efficient than inviting all ever smokers directly for diagnostic spirometry. The thesis then reports the development and external validation of two risk prediction models for COPD using data from electronic health records and a cluster randomised controlled trial. These models can be used to assess the risk of undiagnosed COPD to help target patients for case finding and can potentially be integrated with clinical information systems. Finally, primary care providers were interviewed to explore their views on case finding for COPD, including potential benefits and harms, as well as barriers and facilitators. This suggests that more training and support for community respiratory services may be needed in order to improve the timely diagnosis of COPD
Preview : Published ahead of advance online publication

This is a PDF file of an unedited peer-reviewed manuscript that has been accepted for publication. NPG are providing this early version of the manuscript as a service to our customers. The manuscript will undergo copyediting, typesetting and a proof review before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers apply.
Cerebrolysin for vascular dementia.

BACKGROUND Vascular dementia is a common disorder without definitive treatments. Cerebrolysin seems to be a promising intervention based on its potential neurotrophic and pro-cognitive effects, but studies of its efficacy have yielded inconsistent results. OBJECTIVES To assess the efficacy and safety of Cerebrolysin for vascular dementia. SEARCH METHODS We searched ALOIS - the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 4 November 2012 using the terms: Cerebrolysin, Cere, FPF1070, FPF-1070. ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases, numerous trial registries and grey literature sources. SELECTION CRITERIA All randomized controlled trials of Cerebrolysin for treating vascular dementia without language restriction. DATA COLLECTION AND ANALYSIS Two authors independently selected trials and evaluated the methodological quality, then extracted and analysed data from the included trials. MAIN RESULTS Six randomized controlled trials with a total of 597 participants were eligible. The meta-analyses revealed a beneficial effect of Cerebrolysin on general cognitive function measured by mini-mental state examination (MMSE) (weighted mean difference (WMD) 1.10; 95% confidence interval (CI) 0.37 to 1.82) or Alzheimer's Disease Assessment Scale Cognitive Subpart, extended version (ADAS-cog+) (WMD -4.01; 95% CI -5.36 to -2.66). It also improved patients' global clinical function evaluated by the response rates (relative risk (RR) 2.71, 95% CI 1.83 to 4.00). Only non-serious adverse events were observed in the included trials, and there was no significant difference in occurrence of non-serious side effects between groups (RR 0.97, 95% CI 0.49 to 1.94). AUTHORS' CONCLUSIONS Cerebrolysin may have positive effects on cognitive function and global function in elderly patients with vascular dementia of mild to moderate severity, but there is still insufficient evidence to recommend Cerebrolysin as a routine treatment for vascular dementia due to the limited number of included trials, wide variety of treatment durations and short-term follow-up in most of the trials.
Optimal timing for antiretroviral therapy initiation in patients with HIV infection and concurrent cryptococcal meningitis.

BACKGROUND Currently, initiation of antiretroviral therapy (ART) in most patients with human immunodeficiency virus (HIV) infection is based on the CD4-positive-t-lymphocyte count. However, the point during the course of HIV infection at which ART should be initiated in patients with concurrent cryptococcal meningitis remains unclear. The aim of this systematic review was to summarise the evidence on the optimal timing of ART initiation in patients with cryptococcal meningitis for use in clinical practice and guideline development. OBJECTIVES To compare the clinical and immunologic outcomes for early initiation ART (less than four weeks after starting antifungal treatment) versus later initiation of HAART (four weeks or more after starting antifungal treatment) in HIV-positive patients with concurrent cryptococcal meningitis. SEARCH METHODS We searched the following databases from January 1980 to February 2011: PubMed, EMBASE, and WHO International Clinical Trials Registry Platform, AEGIS database for conference abstracts, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. A total of 35 full text articles were identified and supplemented by a bibliographic search. We contacted researchers and relevant organizations and checked reference lists of all included studies. SELECTION CRITERIA Randomized controlled trials that compared the effect of ART (consisting of three drug combinations) initiated early or delayed in HIV patients with cryptococcal meningitis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and graded methodological quality. Data extraction and methodological quality were checked by a third author who resolved differences when these arose. Where clinically meaningful, we performed a meta-analysis of dichotomous outcomes using the relative risk (RR) and report the 95% confidence intervals (95% CIs). MAIN RESULTS Two eligible randomized controlled trials were included (N = 89). In our pooled analysis, we combined the clinical data for both trials comparing early initiation ART versus delayed initiation of ART. There was no statistically significant difference in mortality (RR=1.40, 95% CI [0.42, 4.68]) in the group with early initiation of ART compared to the group with delayed initiation of ART. AUTHORS' CONCLUSIONS This systematic review shows that there is insufficient evidence in support of either early or late initiation of ART. For the moment, because of the high risk of immune reconstitution syndrome in patients with cryptococcal meningitis, we recommend that ART initiation should be delayed until there is evidence of a sustained clinical response to antifungal therapy. However, large studies with appropriate comparison groups, and adequate follow-up are warranted to provide the evidence base for effective decision making.
Photo-oxidative stress markers as a measure of abiotic stress-induced leaf senescence: advantages and limitations.

Inside chloroplasts, several abiotic stresses (including drought, high light, salinity, or extreme temperatures) induce a reduction in CO2 assimilation rates with a consequent increase in reactive oxygen species (ROS) production, ultimately leading to leaf senescence and yield loss. Photo-oxidation processes should therefore be mitigated to prevent leaf senescence, and plants have evolved several mechanisms to either prevent the formation of ROS or eliminate them. Technology evolution during the past decade has brought faster and more precise methodologies to quantify ROS production effects and damage, and the capacities of plants to withstand oxidative stress. Nevertheless, it is very difficult to disentangle photo-oxidative processes that bring leaf defence and acclimation, from those leading to leaf senescence (and consequently death). It is important to avoid the mistake of discussing results on leaf extracts as being equivalent to chloroplast extracts without taking into account that other organelles, such as peroxisomes, mitochondria, or the apoplast also significantly contribute to the overall ROS production within the cell. Another important aspect is that studies on abiotic stress-induced leaf senescence in crops do not always include a time-course evolution of studied processes, which limits our knowledge about what photo-oxidative stress processes are required to irreversibly induce the senescence programme. This review will summarize the current technologies used to evaluate the extent of photo-oxidative stress in plants, and discuss their advantages and limitations in characterizing abiotic stress-induced leaf senescence in crops.
A waste walk through clinical pharmacy: how do the ‘seven wastes’ of Lean techniques apply to the practice of clinical pharmacists

This study used a ‘Lean’ technique, the ‘waste walk’ to evaluate the activities of clinical pharmacists with reference to the seven wastes described in ‘Lean’ including ‘defects’, ‘unnecessary motion’, ‘overproduction’, ‘transport of products or material’, ‘unnecessary waiting’, ‘unnecessary inventory’ and ‘inappropriate processing’. The objectives of the study were to categorise the activities of ward‐based clinical pharmacists into waste and non‐waste, provide detail around what constitutes waste activity and quantify the proportion of time attributed to each category.
Community pharmacists' experience and perceptions of the New Medicines Service (NMS)

The New Medicines Service (NMS) is provided by community pharmacists in England to support patient adherence after the initiation of a new treatment. It is provided as part of the National Health Service (NHS) pharmacy contractual framework and involves a three‐stage process: patient engagement, intervention and follow‐up. The study aims to explore community pharmacists' experiences and perceptions of NMS within one area of the United Kingdom.
Direct Payments, Independent Living and Mental Health

This report is based on a study of the National Pilot to implement direct payments in mental health which took place across five Local Authority sites in England from February 2001 to July 2003. The evaluation used the experiences of the pilot sites as a vehicle through which to understand the factors involved in successfully implementing direct payments in mental health. The evaluation took place in 2002-2003 during the last year of the pilot. This chapter provides an overview of the direct payments and mental health literature and outlines the background to both the National Pilot and the evaluation.
Randomized, Multicenter, Comparative Study of NEURO versus CIMT in Poststroke Patients with Upper Limb Hemiparesis: The NEURO-VERIFY Study

Background Many poststroke patients suffer functional motor limitation of the affected upper limb, which is associated with diminished health-related quality of life. Aims The aim of this study is to conduct a randomized, multicenter, comparative study of low-frequency repetitive transcranial magnetic stimulation combined with intensive occupational therapy, NEURO (NovEl intervention Using Repetitive TMS and intensive Occupational therapy) versus constraint-induced movement therapy in poststroke patients with upper limb hemiparesis. Methods In this randomized controlled study of NEURO and constraint-induced movement therapy, 66 poststroke patients with upper limb hemiparesis were randomly assigned at 2:1 ratio to low-frequency repetitive transcranial magnetic stimulation plus occupational therapy (NEURO group) or constraint-induced movement therapy (constraint-induced movement therapy group) for 15 days. Fugl–Meyer Assessment and Wolf Motor Function Test and Functional Ability Score of Wolf Motor Function Test were used for assessment. Results No differences in patients' characteristics were found between the two groups at baseline. The Fugl–Meyer Assessment score was significantly higher in both groups after the 15-day treatment compared with the baseline. Changes in Fugl–Meyer Assessment scores and Functional Ability Score of Wolf Motor Function Test were significantly higher in the NEURO group than in the constraint-induced movement therapy group, whereas the decrease in the Wolf Motor Function Test log performance time was comparable between the two groups (changes in Fugl–Meyer Assessment score, NEURO: 5·39 ± 4·28, constraint-induced movement therapy: 3·09 ± 4·50 points; mean ± standard error of the mean; P < 0·05) (changes in Functional Ability Score of Wolf Motor Function Test, NEURO: 3·98 ± 2·99, constraint-induced movement therapy: 2·09 ± 2·96 points; P < 0·05). Conclusions The results of the 15-day rehabilitative protocol showed the superiority of NEURO relative to constraint-induced movement therapy; NEURO improved the motion of the whole upper limb and resulted in functional improvement in activities of daily living.
Poststroke Anxiety is Prevalent at the Population Level, Especially among Socially Deprived and Younger Age Community Stroke Survivors

Background Most studies of poststroke anxiety prevalence are hospital based, so knowledge of anxiety in community stroke survivors is limited. Few studies address the association between poststroke anxiety and patient age. No study has explored the relationship between poststroke anxiety prevalence and social deprivation. Aims This study aims to describe population level prevalence data of poststroke anxiety and to explore association of poststroke anxiety prevalence with patient age, gender, and social deprivation. Methods Observational study of 3831 community stroke survivors attending general practice reviews from April 1, 2009 to March 31, 2010 in Greater Glasgow, United Kingdom. Univariate and multivariate analyses investigated the association between poststroke anxiety prevalence (Hospital Anxiety and Depression Scale: anxiety sub-scale [HADS-A]), age, gender, and deprivation variables. Results Six hundred eighteen (16·1%) of 3831 community-dwelling stroke survivors had definite abnormal mood on HADS-A (≥11), with 952 (31·5%) scoring ≥8. Sixty-five (35·5%) of stroke survivors aged under 50 years had definite abnormal mood on HADS-A compared with 59 (7·2%) of over 80 year olds. Three hundred forty (19·8%) of women had definite abnormal mood on HADS-A compared with 278 (13·1%) of men. Three hundred seventy-two (22·6%) of most deprived stroke survivors had definite abnormal mood on HADS-A compared with 49 (7·6%) of least deprived. Age, gender, and social deprivation all contributed significantly to HADS-A score variance. Conclusion Using a conservative HADS-A cutoff, a high prevalence of definite abnormal anxiety in community stroke survivors is observed. This prevalence increases markedly in younger and more socially deprived stroke survivors.
Testing Devices for the Prevention and Treatment of Stroke and its Complications

We are entering a challenging but exciting period when many new interventions may appear for stroke based on the use of devices. Hopefully these will lead to improved outcomes at a cost that can be afforded in most parts of the world. Nevertheless, it is vital that lessons are learnt from failures in the development of pharmacological interventions (and from some early device studies), including inadequate preclinical testing, suboptimal trial design and analysis, and underpowered studies. The device industry is far more disparate than that seen for pharmaceuticals; companies are very variable in size and experience in stroke, and are developing interventions across a wide range of stroke treatment and prevention. It is vital that companies work together where sales and marketing are not involved, including in understanding basic stroke mechanisms, prospective systematic reviews, and education of physicians. Where possible, industry and academics should also work closely together to ensure trials are designed to be relevant to patient care and outcomes. Additionally, regulation of the device industry lags behind that for pharmaceuticals, and it is critical that new interventions are shown to be safe and effective rather than just feasible. Phase IV postmarketing surveillance studies will also be needed to ensure that devices are safe when used in the ‘real-world’ and to pick up uncommon adverse events.
Factors influencing lifestyle behaviours during and after a gestational diabetes mellitus pregnancy

Objective: This qualitative study examined the healthy lifestyle behaviours undertaken during and after a pregnancy complicated by gestational diabetes mellitus (GDM) and the factors that influenced the likelihood of undertaking of such behaviours. Methods: Semi-structured telephone interviews were conducted with women who had a pregnancy complicated by GDM in the previous 3–7 years. Interviews were analysed using a theoretical thematic analysis approach. Results: Thirteen women provided interviews as part of this study. Women typically engaged in healthy behaviours in terms of diet, physical activity and glucose monitoring during their GDM pregnancy, but generally these behaviours were not maintained postpartum. Women appear not to be intrinsically motivated to engage in healthy lifestyle behaviours, but rather require the support of an extrinsic motivator such as their unborn child or the support of healthcare professionals. A gap exists between women's knowledge of their increased long-term diabetes risk and the behaviours which they undertake to reduce this risk in the postpartum period. Conclusion: Women with previous GDM need increased support in the postpartum period to assist them to develop self-management and prioritisation skills to take control of their increased type 2 diabetes mellitus risk.
A collaborative sequential meta-analysis of individual patient data from randomized trials of endovascular therapy and tPA vs. tPA alone for acute ischemic stroke: ThRombEctomy And tPA (TREAT) analysis: statistical analysis plan for a sequential meta-analysis performed within the VISTA-Endovascular 

Rationale Endovascular treatment has been shown to restore blood flow effectively. Second-generation medical devices such as stent retrievers are now showing overwhelming efficacy in clinical trials, particularly in conjunction with intravenous recombinant tissue plasminogen activator. Aims and Design This statistical analysis plan utilizing a novel, sequential approach describes a prospective, individual patient data analysis of endovascular therapy in conjunction with intravenous recombinant tissue plasminogen activator agreed upon by the Thrombectomy and Tissue Plasminogen Activator Collaborative Group. Study outcomes This protocol will specify the primary outcome for efficacy, as ‘favorable’ outcome defined by the ordinal distribution of the modified Rankin Scale measured at three-months poststroke, but with modified Rankin Scales 5 and 6 collapsed into a single category. The primary analysis will aim to answer the questions: ‘what is the treatment effect of endovascular therapy with intravenous recombinant tissue plasminogen activator compared to intravenous tissue plasmi-nogen activator alone on full scale modified Rankin Scale at 3 months? ’ and ‘to what extent do key patient characteristics influence the treatment effect of endovascular therapy? ’. Key secondary outcomes include effect of endovascular therapy on death within 90 days; analyses of modified Rankin Scale using dichotomized methods; and effects of endovascular therapy on symptomatic intracranial hemorrhage. Several secondary analyses will be considered as well as expanding patient cohorts to intravenous recombinant tissue plasminogen activator-ineligible patients, should data allow. Discussion This collaborative meta-analysis of individual participant data from randomized trials of endovascular therapy vs. control in conjunction with intravenous thrombolysis will demonstrate the efficacy and generalizability of endovascular therapy with intravenous thrombolysis as a concomitant medication.
Silodosin versus naftopidil in Japanese patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: A randomized multicenter study

Silodosin is a novel drug that is highly selective to subtype alpha 1A and, since 2006, has been used in Japan for treating benign prostatic hyperplasia. This study aimed to compare the clinical effects of the alpha‐adrenoceptor antagonist, silodosin, with those of naftopidil in patients presenting lower urinary tract symptoms associated with benign prostatic hyperplasia.