Miracle-dz/UniFAR-FTUs huggingface dataset:
Researching Ones Own Clinical Practice: Managing Multiple Roles in an Action Research Project

Action Research is a useful approach for practitioners who want to develop or improve on their everyday activity, while simultaneously contributing to a scientific body of knowledge. Action Researchers need to be able to reflect critically on their actions and interpretations, and be aware of their biases. This becomes increasingly complex and important when the researcher is engaged in multiple roles during the research process. This paper describes some of the dilemmas encountered by a music therapist using Action Research to develop a music therapy consultation protocol while simultaneously gathering data for a thesis towards a PhD in Music. The use of a research journal as an aid to self-understanding is discussed.
Psychosoziale Krankheitsbelastungen und Lebensqualität beim Lymphödem

Obwohl die Erforschung der Lebensqualitat in den letzten Jahren zunehmend an Bedeutung gewonnen hat, gibt es bisher kaum Untersuchungen zur Krankheitsbelastung beim chronischen Lymphodem. Die wenigen publizierten Arbeiten betreffen vorwiegend Frauen mit sekundarem Lymphodem nach Brustkrebsbehandlung. Sie zeigen, das diese Patienten unter zahlreichen funktionellen und psychosozialen Belastungen leiden. Neben der Bewegungsbeeintrachtigung der betroffenen Extremitat fallt vielen Frauen vor allem das Annehmen des neuen, disproportionierten Korpers schwer. Verbunden mit Einschrankungen der Arbeits- und Leistungsfahigkeit bedeutet dies fur viele Patienten eine Einschrankung ihres Selbstwertgefuhls und ihrer Lebensqualitat. Weitere Studien mit verbesserten Methoden der Lebensqualitatserfassung sind notwendig, um Patienten mit besonders hohen zu erwartenden Belastungen im Vorfeld zu erkennen und rechtzeitig zu behandeln.
Procedural sedation with dexmedetomidine during ablation of atrial fibrillation: a randomized controlled trial.

AIMS Procedural sedation by non-anaesthesiologists with GABAergic anaesthetics has the potential risk of fatal respiratory depression. Dexmedetomidine works its sedative action via α2-adrenergic receptors, and is less associated with respiratory depression. We tested the usability of dexmedetomidine as a procedural sedative during ablation of atrial fibrillation (AF). METHODS AND RESULTS Consecutive patients were randomized to be treated with dexmedetomidine (n = 43) or thiamylal (n = 44) as sedatives during AF ablation. Apnoeic and body movement events were monitored using a novel portable respiratory monitor, the SD-101, during the procedure. Although the majority of the patients receiving dexmedetomidine required rescue sedations with thiamylal, the respiratory disturbance index (RDI) defined as the total number of sleep-disordered breathing events divided by the recording time (10.4 ± 5.1 vs. 18.2 ± 8.1 events/h; P < 0.0001) and movement index defined as the number of body movement events per hour (7.6 ± 6.1 vs. 11.0 ± 5.5 events/h; P = 0.0098) were both significantly lower in the dexmedetomidine arm than in the thiamylal arm. A multivariate linear regression analysis including potential factors revealed that dexmedetomidine vs. thiamylal was solely and independently associated with the RDI (β = -0.62; P = 0.0031). The occurrence of hypotension [9 (21%) vs. 4 (9%); P = 0.14] and bradycardia [4 (9%) vs. 4 (9%); P = 1.0] were similar in the patients with dexmedetomidine and thiamylal. CONCLUSION Procedural sedation with dexmedetomidine may assure safety and patient immobility during AF ablation, and therefore may be a potential alternative for that with GABAergic anaesthetics.
APhA Academies reflect on the Pharmacists’ Patient Care Process of the Joint Commission of Pharmacy Practitioners

Applying the patient care process in practice The Pharmacists’ Patient Care Process is not net new; it is generally the care pharmacists have historically been providing patients in all practice settings. What is new is the development of a contemporary consensus-based document supported by national pharmacy organizations that articulates how all pharmacists in all care settings should be providing care. The document also recognizes key elements within each step of care. Regardless of the setting (e.g., hospital, community, clinic, long-term care, or managed care), when a patient receives care from a pharmacist, the process performed by the pharmacist is the same. APhA–APPM Overview of pharmacists’ patient care process Pharmacy practice is evolving into patient-centered care with the pharmacist serving as an accountable and integral member of the health care team. To refl ect this change, in November 2013, the Joint Commission of Pharmacy P r a c t i t i o n e r s (JCPP) adopted a vision for pharmacy practice that states, “Patients achieve optimal health and medication outcomes with pharmacists as essential and accountable providers, within patient-centered team-based health care. ” The JCPP identifi ed three key drivers to reach the vision: (1) development, adoption, and implementation of a consistent, uniform, and widely applied patient care process; (2) quality measures to quantify the value of services provided; and (3) robust health information technology to support patient care and payment for pharmacists’ services.1 The fi rst key driver, the Pharmacists’ Patient Care Process, was developed through a review of several recognized resources on pharmaceutical care and medication therapy management using a collaborative, consensus-based process. The fi nal document was adopted for implementation by JCPP in May 2014 and supported by 13 national pharmacy organizations.2 The process includes the following fi ve steps: collect, assess, plan, implement, and follow up: monitor and evaluate (Figure 1). As the role of pharmacists transforms in the health care system, implementation of a uniform patient care process establishes and promotes consistent expectations about pharmacist-provided patient care to patients, health care providers, payers, and regulatory bodies. In addition, a consistent process of care is needed to deliver services that permit objective measurement of patient care outcomes and quality measures that are comparable from one pharmacist to another and from one setting to another across the health care system. Regardless of
Health economic evaluation of single-lead atrial pacing vs. dual-chamber pacing in sick sinus syndrome.

AIMS The recent Danish Multicentre Randomized Trial on Single-Lead Atrial (AAIR) Pacing versus Dual-Chamber (DDDR) Pacing in Sick Sinus Syndrome (DANPACE) suggested DDDR pacing as standard care. However, previous findings supported the routine use of AAIR pacing. This study investigated the cost-effectiveness of DDDR pacing compared with AAIR pacing for sick sinus syndrome. METHODS AND RESULTS A decision-analytical model based on patient-level data from three randomized trials was designed from the Danish healthcare system's perspective. The main outcomes were lifetime costs, quality-adjusted lifeyears (QALYs), and net monetary benefit. Quality-adjusted lifeyears were calculated by utilizing community-based preferences. Costs were calculated by utilizing the extensive data on resource consumption, from the DANPACE trial. Data were pooled and adjusted for baseline differences. Dual-chamber pacing was shown to be cost-effective in all the analyses using a willingness-to-pay (WTP) threshold of £20,000/QALY, and most analyses using a WTP of £30,000/QALY. When pooling the data and adjusting for baseline differences, Monte Carlo simulations revealed a 51-71% probability of DDDR pacing being cost-effective at a WTP of £20,000/QALY, and a 42-58% probability at a WTP of £30,000/QALY. Dual-chamber pacing was most likely to be cost-effective among elderly patients with comorbidity. The expected value of perfect information was low and initiation of additional publicly funded Danish trials was discouraged. CONCLUSION Dual-chamber pacing is likely to be a cost-effective treatment for sick sinus syndrome patients.
An electrocardiography algorithm combined with clinical features could localize the origins of focal atrial tachycardias in adjacent structures.

AIMS It is difficult to differentiate the origins of focal atrial tachycardias (ATs) in adjacent structures by electrocardiography (ECG) alone. The aim of this study was to evaluate whether the clinical features of these ATs may help differentiate their origins. METHODS AND RESULTS One hundred and ninety-four patients (mean age, 43.5 ± 17.9 years; male, 53.6%) who underwent electrophysiological study for focal AT were included. We evaluated accuracy in differentiating the origin of AT by using ECG alone as well as with the addition of the clinical features. Electrocardiographs of ATs originating from the left superior pulmonary vein (LSPV, n = 24) vs. the left atrial appendage (LAA, n = 6), and from the right superior pulmonary vein (RSPV, n = 14) vs. the superior vena cava (SVC, n = 8) showed similar patterns. However, while no ATs from the LAA were found to be related to paroxysmal atrial fibrillation, 22 out of 24 ATs from the LSPV were associated with this condition. After localizing AT by using ECG, this clinical feature helped differentiate the ATs from the LSPV vs. the LAA with 93% accuracy. Moreover, while an on-and-off tachycardia (initiated and terminated more than 10 times per day) was observed in 4 of 8 ATs from the SVC, this pattern was observed in 13 of 14 ATs from the RSPV. After localizing the ATs by using ECG, on-and-off tachycardia helped differentiate the ATs from the RSPV vs. the SVC with 82% accuracy. CONCLUSION The clinical features and Holter monitoring can give additional information for differentiating the focal ATs originating from the adjacent structures.
Successful pacing using a batteryless sunlight-powered pacemaker.

AIMS Today's cardiac pacemakers are powered by batteries with limited energy capacity. As the battery's lifetime ends, the pacemaker needs to be replaced. This surgical re-intervention is costly and bears the risk of complications. Thus, a pacemaker without primary batteries is desirable. The goal of this study was to test whether transcutaneous solar light could power a pacemaker. METHODS AND RESULTS We used a three-step approach to investigate the feasibility of sunlight-powered cardiac pacing. First, the harvestable power was estimated. Theoretically, a subcutaneously implanted 1 cm(2) solar module may harvest ∼2500 µW from sunlight (3 mm implantation depth). Secondly, ex vivo measurements were performed with solar cells placed under pig skin flaps exposed to a solar simulator and real sunlight. Ex vivo measurements under real sunlight resulted in a median output power of 4941 µW/cm(2) [interquartile range (IQR) 3767-5598 µW/cm(2), median skin flap thickness 3.0 mm (IQR 2.7-3.3 mm)]. The output power strongly depended on implantation depth (ρSpearman = -0.86, P < 0.001). Finally, a batteryless single-chamber pacemaker powered by a 3.24 cm(2) solar module was implanted in vivo in a pig to measure output power and to pace. In vivo measurements showed a median output power of >3500 µW/cm(2) (skin flap thickness 2.8-3.84 mm). Successful batteryless VVI pacing using a subcutaneously implanted solar module was performed. CONCLUSION Based on our results, we estimate that a few minutes of direct sunlight (irradiating an implanted solar module) allow powering a pacemaker for 24 h using a suitable energy storage. Thus, powering a pacemaker by sunlight is feasible and may be an alternative energy supply for tomorrow's pacemakers.
Effects of formoterol on endurance performance in athletes at an ambient temperature of −20°C

The use of inhaled β2‐agonists is restricted in sports. No benefit of inhaled formoterol upon performance was found in healthy athletes under normal climatic conditions, but it has not been investigated whether formoterol improves performance in athletes during exposure to cold. To investigate the effect of inhaled formoterol vs placebo upon performance and lung function at −20°C in 20 healthy male athletes. We used a randomized double‐blind, placebo‐controlled, cross‐over design. The subjects performed a run until exhaustion after inhaled study drug. The speed was 95% of the predetermined maximal oxygen uptake (V̇O2 max) the first minute and increased to 107% of V̇O2 max for the remaining part of the test. Time until exhaustion, ventilation (V̇E), V̇O2, respiratory rate (RR), tidal volume (VT), heart rate (HR) and arterial oxyhemoglobin saturation (SPO2) were recorded during exercise. Lung function was measured before inhaling, after inhaling the study drug and after the treadmill run. Inhaled formoterol did not improve endurance performance in cold environments compared with placebo, although formoterol significantly improved lung function (FEV1, FEF50 and PEF) and HR 4 min after the start of the exercise. Inhaled formoterol did not improve endurance performance in healthy, well‐trained athletes exposed to cold.
The definition of valvular and non-valvular atrial fibrillation: results of a physicians' survey.

AIMS To assess different aspects of the definition of valvular/non-valvular atrial fibrillation (AF) used in clinical practice by physicians who usually treat this condition. METHODS AND RESULTS We prospectively conducted a web-based survey including cardiologists and internists who attended continuing medical education courses on cardiovascular medicine. A questionnaire was drawn up, containing 17 questions clustered into five main topics: (A) known rheumatic aetiology; (B) site/type of valve involvement; (C) prosthetic heart valve; (D) haemodynamic relevance; (E) miscellaneous. The overall response rate was 22.4% (21.1% for cardiologists and 24% for internists). Coexistence of both medical history of rheumatic disease and clinical signs of valvular involvement were considered as essential prerequisites for the diagnosis of rheumatic AF by half of the respondents, and one-third assumed that lone aortic valve disease was sufficient for AF to be defined as valvular. A similar proportion of respondents considered that in the presence of mitral regurgitation, AF had to be defined as valvular. The majority of responding physicians considered the degree of valvular defect of lesser importance for the definition of valvular or non-valvular origin of AF. CONCLUSION We found important heterogeneity and uncertainties in the answers given by physicians who usually treat patients with AF, as evidence of the lack of precise and unique definitions of the origin of AF (valvular/non-valvular). It is urgent to issue clear widely accepted definitions of the origin of AF, which should improve clinical practice and research.
The pathophysiology and treatment of glaucoma: a review.

IMPORTANCE Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition. OBJECTIVE To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma. EVIDENCE REVIEW A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians. FINDINGS The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression. CONCLUSIONS AND RELEVANCE Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries.
Application of phase coherence in assessment of spatial alignment of electrodes during simultaneous endocardial-epicardial direct contact mapping of atrial fibrillation.

AIMS Mapping and interpretation of wave conduction patterns recorded during simultaneous mapping of the electrical activity on both endocardial and epicardial surfaces are challenging because of the difficulty of reconstruction of reciprocal alignment of electrodes in space. Here, we suggest a method to overcome this difficulty using a concept of maximized endo-epicardial phase coherence. METHODS AND RESULTS Endo-epicardial mapping was performed in six humans during induced atrial fibrillation (AF) in right atria using two sets of 8 × 8 electrode plaques. For each electrode, mean phase coherence (MPC) with all electrodes on the opposite side of the atrial wall was calculated. Localization error was defined as a distance between the directly opposing electrode and the electrode with the maximal MPC. Overall, there was a linear correlation between MPC and distance between electrodes with R(2) = 0.34. Localization error obtained for electrodes of the plaque in six patients resulted in a mean 2.3 ± 1.9 mm for 25 s electrogram segment length. Eighty-four per cent of the measurements resulted in error smaller than 3.4 mm. The duration of the recording used to compute MPC was negatively correlated with localization error; however, the effect reached plateau for segment durations longer than 15 s. CONCLUSION Application of the concept of maximized endo-epicardial phase coherence to electrograms during AF allows reconstruction of reciprocal alignment of the electrodes on the opposite side of the atrial wall. This approach may be especially useful in settings where the spatial position of endo- and epicardial electrodes for intracardiac mapping cannot otherwise be determined.
Predicting cetacean abundance and distribution in a changing climate

Changes in abundance and shifts in distribution as a result of a warming climate have been documented for many marine species, but opportunities to test our ability to forecast such changes have been limited. This study evaluates the ability of habitat‐based density models to accurately forecast cetacean abundance and distribution during a novel year with unprecedented warm ocean temperatures caused by a sustained marine heatwave.
Visual Acuity after Retinal Gene Therapy for Choroideremia.

In this study, the subfoveal injection of a gene-therapy vector carrying nonmutated CHM, the gene that, when mutated, causes a form of blindness called choroideremia, was followed by an improvement in visual acuity in two of six patients at 3.5 years after injection.
Association between hospital procedure volume and early complications after pacemaker implantation: results from a large, unselected, contemporary cohort of the German nationwide obligatory external quality assurance programme.

AIMS Several studies demonstrated an inverse relationship between cardioverter-defibrillator implantation volume and complication rates, suggesting better outcomes for higher volume centres. However, the association of institutional procedural volume with patient outcomes for permanent pacemaker (PPM) implantation remains less known, especially in decentralized implantation systems. METHODS AND RESULTS We performed retrospective examination of data on patients undergoing PPM from the German obligatory quality assurance programme (2007-12) to evaluate the relationship of hospital PPM volume (categorized into quintiles of their mean annual volume) with risk-adjusted in-hospital surgical complications (composite of pneumothorax, haemothorax, pericardial effusion, or pocket haematoma, all requiring intervention, or device infection) and pacemaker lead dislocation. Overall 430 416 PPM implantations were documented in 1226 hospitals. Systems included dual (72.8%) and single (25.8%) chamber PPM and cardiac resynchronization therapy (CRT) devices (1.1%). Complications included surgical (0.92%), and ventricular (0.99%), and atrial (1.22%) lead dislocation. Despite an increase in relatively complex procedures (dual chamber, CRT), there was a significant decrease in the procedural and fluoroscopy times and complications from lowest to highest implantation volume quintiles (P for trend <0.0001). The greatest difference was observed between the lowest (1-50 implantations/year-reference group) and the second-lowest (51-90 implantations/year) quintile: surgical complications [odds ratio (OR) 0.69; confidence interval (CI) 0.60-0.78], atrial lead dislocations (OR 0.69; CI 0.59-0.80), and ventricular lead dislocations (OR 0.73; CI 0.63-0.84). CONCLUSIONS Hospital annual PPM volume was directly related to indication-based implantation of relatively more complex PPM and yet inversely with procedural times and rates of early surgical complications and lead dislocations. Thus, our data suggest better performance and lower complications with increasing procedural volume.