Miracle-dz/UniFAR-FTUs huggingface dataset:
Effects of Buprenorphine and Hepatitis C on Liver Enzymes in Adolescents and Young Adults

Objective:The purpose of this study was to explore changes in transaminase values associated with buprenorphine treatment and hepatitis C status among opioid-dependent subjects aged 15 to 21 years. Methods:One hundred fifty-two subjects seeking treatment for opioid dependence were randomized to 2-week detoxification with buprenorphine/naloxone (DETOX) or 12 weeks with buprenorphine/naloxone (BUP). Liver chemistries including transaminases were obtained baseline and at 4, 8, and 12 weeks. One hundred eleven patients had at least one set of transaminases during treatment and were included in analyses of treatment effects. Results:Overall, 8 of the 60 BUP participants versus 12 of the 51 DETOX participants had at least one elevated alanine aminotransferase value during follow-up (&khgr;2 = ns). Five of the 60 BUP participants versus 11 of the 51 DETOX participants had at least one elevated aspartate aminotransferase value (&khgr;2 = 3.194, P = 0.048). Twenty eight of the 152 participants were hepatitis C (HCV) positive at baseline and 4 seroconverted within 12 weeks, 2 in each group. HCV status was significantly associated with transaminase abnormalities (P = 0.009 and 0.006 for alanine aminotransferase and aspartate aminotransferase, respectively). HCV status had a strong effect on transaminase abnormalities among participants assigned to DETOX, but not among those assigned to BUP. Conclusions:No evidence was found for hepatotoxicity of buprenorphine in this exploratory analysis. HCV was present in a significant minority of participants and was a significant predictor of transaminase elevation. Results suggest that stabilization on buprenorphine may decrease the frequency of transaminase abnormalities associated with HCV in opioid-dependent young people. The high rate of seroconversion underscores the importance of effective treatment and prevention.
Attitudes of Methadone Program Staff Toward Provision of Harm-Reduction and Other Services

Objective:The need for expansion of health services provided in drug treatment programs has been widely discussed since the beginning of the HIV epidemic among drug users. Service expansion has focused on various types of services including medical services (eg, primary care) and harm-reduction services (eg, provision of sterile syringes). Methods:A staff survey was conducted in 8 methadone maintenance clinics in the New York/New Jersey area to assess attitudes toward the provision of harm reduction and other services in methadone clinics, and the relationship of these attitudes to other variables. Participants:A total of 114 staff members in 8 methadone maintenance clinics completed the survey. Results:The majority of staff was supportive of adding services, over 90% supported medical services, and the majority supported harm-reduction services such as syringe access and disposal services. Higher education and HIV knowledge levels were significant correlates of favorable attitudes toward service provision. Conclusions:Support for providing harm-reduction services in methadone maintenance clinics was found. Enhancing knowledge of staff regarding various types of health services, and engaging them in how best to institute new services, should be undertaken when new services are planned.
Multi-objective homecare worker scheduling: A fuzzy simulated evolution algorithm approach

As the need for improved homecare services continues to rise in every society, homecare service providers need to develop efficient staff scheduling methods. Homecare services are aimed at providing medical, paramedical, and social aid to patients at their own homes, leading to reduced hospitalization and healthcare operations costs in the medium to long term. However, the home healthcare worker scheduling problem is a complex one since it combines the hard vehicle routing and the staff assignment problems. As such, the purpose of this research is to present a fuzzy simulated evolution algorithm, based on fuzzy evaluation techniques, to address the homecare worker scheduling problem in a home care environment. The main objective is to decide on (i) which patients to assign to each worker, and (ii) the best route or trip for each care giver to execute the healthcare tasks so as to satisfy the patient's preferences in the time window during which the care giver should visit and offer the requested healthcare service. Computational results on illustrative experiments show that the proposed algorithm is a promising decision support tool.
Introducing humanistic group counselling for somatisation in a primary care practice: Preliminary findings

Can group counselling help patients who present with symptoms that cannot be explained medically? Preliminary results of working with one such group are reported. Six patients in a primary care practice were offered weekly sessions for half a year. The findings suggest that the patients attended all group sessions. The patients reported experiences known to be related to group counselling, and when the group ended, patient reports show that the severity of their problems was reduced significantly (p<.001). Furthermore, during the six months after the group ended patients significantly (p<.025) reduced their visits to their general practitioners. These results seem to call for wider use of humanistic group counselling with somatising patients and further research into the impact of such form of counselling.
INTESTINAL FLORA IN NEW-BORN INFANTS: WITH A DESCRIPTION OF A NEW PATHOGENIC ANAEROBE, BACILLUS DIFFICILIS

Following our first article on the bacterial flora of first passage specimens of meconium from fifty new-born infants1we studied the daily microbial changes in the feces of ten normal breast-fed infants up to the tenth day, when they left the hospital. HISTORICAL REVIEW The early invasion of the intestinal tracts of new-born infants by bacteria, either ascending or descending, often within ten hours after birth and before feeding, first observed microscopically by Breslau2in 1866, was confirmed by Billroth3in 1874 and by Nothnagel4in 1881. Using iodine as a stain, Nothnagel assumed to identify Saccharomyces ellipsoideus, Bacillus subtilis and the so-called clostridium of Prazmowski, which he regarded as identical with Bacillus amylobacter of Trecul and van Tieghem and the "vibrion septique" of Pasteur; but we feel that even now, with greatly improved methods of staining, identification of any of these is impossible. Nothnagel was
Analysis of Goal-directed Fluid Therapy and Patient Monitoring in Enhanced Recovery After Surgery

Enhanced recovery after surgery (ERAS) includes multimodal interventions organized into patient care pathways and applied throughout the perioperative period. ERAS pathways in colorectal surgery are well described in the literature, and ERAS pathways have also been adopted for other surgical subspecialties including urology, hepatic surgery, laparoscopic surgery, and others. The goal of an ERAS pathway is to reduce postoperative complications and aid in recovery of baseline functional status, leading to shorter lengths of stay and reduced cost. Components of ERAS pathways include preoperative medical optimization, preoperative carbohydrate loading, and prevention of postoperative ileus through judicious use of opiates and non–opiate-based pain management techniques. Goal-directed fluid therapy (GDFT) is an evolving component of ERAS pathways. The perioperative clinician should understand the concepts behind GDFT, the principles of fluid responsiveness and fluid therapy, the utility of hemodynamic variables used for GDFT, and which GDFT strategies can affect surgical outcomes.
Visual search characteristics in mammography: malignant vs benign breast masses

Mammography screening is the most widely utilized tool to screen for breast cancer. Radiologists read a mammogram using a two-pass strategy where the first pass is guided by salient features of the image (the so-called 'pop-out' elements), and the second pass is a systematic search. It is assumed that most breast masses that are reported by the radiologist are in fact detected during the first pass of this search strategy, and that the second pass is useful for the detection of microcalcification clusters. Furthermore, experiments in other visual domains have shown that observers are attracted faster to incongruous elements in a display than to normal (i.e., more expected) elements. In this sense, it can be argued that benign findings constitute more expected findings, because they encompass a large percentage of all abnormalities found on a mammogram. In this experiment we sought to determine whether the search for malignant masses was indeed faster than the search for benign masses. We also aimed to determine whether the observers' overall visual search behavior was different between benign and malignant cases, not only in terms of how long it took the observers to hit the location of the lesion, but also how long the observers took analyzing the case, how different the distribution of false positive responses were between the two types of cases, etc.
Capacidade funcional de indivíduos com insuficiência cardíaca avaliada pelo teste de esforço cardiopulmonar e classificação da New York Heart Association

The purpose of this study was to evaluate the capacity of the New York Heart Association (NYHA) classification to discriminate heart failure (HF) individuals classes II and III using cardiopulmonary exercise test (CPET) variables. Seventeen patients class II (age 44.47±10.11 years; ejection fraction 32.11±10.37%) and 15 class III (age 46.73±8.74 years; ejection fraction 30.46±10.23%) of NYHA participated in this study. They did a maximal CPET in a treadmill ergometer. According to the distribution of data, correlation of Pearson or Spearman was performed and, to compare the functional classes of NYHA, the Student's t-test was used. Significant correlations (p<0.05) between oxygen consumption (VO2) and oxygen pulse (r=0.76), age (r=0.35) and body mass index (r=0.45) were found. There was no significant correlation between ventricular ejection fraction and the others studied variables. Comparing the functional classes of NYHA, significantly differences were found to VO2 and oxygen pulse (p<0.05). In this study, the correlations reflect the complexity in analyzing and understanding the process of disfunction in HF, once probably other factors influence each of the variables studied. The classification of NYHA was effective to differentiate the patients with HF, reinforcing the indication of this stratification to identify different groups of HF patients to scientific researches and therapeutic interventions.
Impact of a Culturally Sensitive Health Self-Empowerment Workshop Series on Health Behaviors/Lifestyles, Body Mass Index, and Blood Pressure of Culturally Diverse Overweight/Obese Adults

Objective. To examine the impact of the health self-empowerment theory–based, culturally sensitive Health Self-Empowerment (HSE) Workshop Series to Modify and Prevent Obesity on levels of health promoting (health-smart) behaviors, motivators of and barriers to these behaviors, health promoting lifestyle variables, and health status indicators (body mass index [BMI] and blood pressure) among a culturally diverse sample of overweight/obese adults from mostly low-income households. Design. A total of 153 overweight/obese adults participated in an immediate treatment (IT) group (n = 100) or a waitlist control (WC) group (n = 53). Results. Post-intervention, the IT group compared with the WC group reported (a) significantly higher engagement in physical activity and healthy eating; (b) significantly less intake of calories, total fat, trans fat, saturated fat, sugar, and added sugar; (c) significantly higher motivators for engaging in 2 of 4 specific health-smart behaviors; (d) significantly lower barriers to engaging in 3 of 4 specific health-smart behaviors; and (e) significantly lower BMI and systolic blood pressure. Conclusion. The HSE Workshop Series may be an effective intervention for treating and preventing obesity among diverse low-income adults—individuals who often perceive/experience limited power over their health. Health care providers, particularly physicians, have important health empowerment roles in this intervention.
Community-acquired pneumonia: An overview

Abstract Community-acquired pneumonia is still a significant cause of morbidity and mortality and is often misdiagnosed and inappropriately treated. Although it can be caused by a wide variety of micro-organisms, the pneumococcus, atypicals, such as Mycoplasma pneumoniae and Chlamydophila pneumoniae, Staphylococcus aureus and certain Gram-negative rods are the usual pathogens encountered. The site-of-care decision is critical in determining the site and type of care as well as the extent of diagnostic workup. Antimicrobial therapy should be started as soon as possible particularly in those requiring admission to hospital, but typically the physician does not know with any degree of certainty the identity of the etiologic pathogen. A number of national guidelines have been published to help the physician with this choice. The initial drug(s) can be modified if necessary if the pathogen and its antimicrobial susceptibility pattern becomes known. Adjunctive therapy such as pressors and fluid replacement are of value and macrolides appear to help as well, likely secondary to their immunomodulatory effects. Recent data also suggest a role for steroids.
Postprandial plasma glucose effects of once-weekly albiglutide for the treatment of type 2 diabetes

ABSTRACT Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) vary in their structure, duration of action, efficacy, and safety. In order to optimize glycemic control, it is important to target both fasting (FPG) and postprandial plasma (PPG) glucose. Although phase 3 trials document the effect of GLP-1 RAs on glycated hemoglobin, few data are available to assess their effect on PPG. Albiglutide is a once-weekly GLP-1 RA with a half-life of ≈ 5 days. The goal of this review is to summarize the effects of albiglutide on PPG in four phase 2 trials and to describe the PPG-lowering effects of the GLP-1 RAs. At clinically relevant doses (30-64 mg), albiglutide consistently lowered PPG after each meal in addition to its effect on lowering FPG. Multiple weekly subcutaneous injections of albiglutide led to improvements in a variety of glycemic measures, including maximal reductions in PPG from baseline, postmeal glucose excursions, and FPG. Albiglutide, a longer-acting GLP-1 RAs, provides reductions in FPG, PPG following meals, and glucose over 24 hours.
Online therapy: Implications for problem gamblers and clinicians1

It is clear that clinicians working in the field of problem gambling cannot afford to ignore the Internet. Psychological advice, help and treatment for gamblers are no exceptions with both counselling and psychotherapy entering the computer age. Such help comes under a variety of guises including Internet counselling, online therapy, webcounselling, cybertherapy, E-therapy, and cybercounselling (all on this partial list tend to get used interchangeably). Although there is no official description of how to define this activity, a common component of all these methods is that people logging into these Internet services are receiving psychological advice and/or 'treatment' at hundreds of websites. Predictably, the subject of Internet counselling is causing wide debate (especially on the Internet itself! ). This paper overviews the main issues in the area and briefly examines 'telehealth', online therapy (and the various types currently available), the relative advantages and disadvantages of online therapy, and the implications for the treatment of problem gamblers. The authors approach this discussion acknowledging that online therapy has to be incorporated within the overall framework of the need for clinical assistance.
Despite all we Know about Collaborative Working, Why do we Still Get it Wrong?

There is a fund of practical and theoretical advice on how to work effectively in collaboration, but in reality outcomes are often disappointing. This paper explores aspects that frequently derail well‐intentioned collaborative endeavours, drawing on research on integration in health and social care in Wales to highlight four particular areas of concern: motivation and meaning, capacity and capability, learning, and conceptualising and measuring success. Arguing that better management of these factors should improve overall effectiveness, it concludes with a plea for greater understanding of the complex interplay between structural factors and the influences of individuals.
A Rapid Evidence Assessment of Immersive Virtual Reality as an Adjunct Therapy in Acute Pain Management in Clinical Practice

Objectives:Immersive virtual reality (IVR) therapy has been explored as an adjunct therapy for the management of acute pain among children and adults for several conditions. Therapeutic approaches have traditionally involved medication and physiotherapy but such approaches are limited over time by their cost and side effects. This review seeks to critically evaluate the evidence for and against IVR as an adjunctive therapy for acute clinical pain applications. Methods:A rapid evidence assessment (REA) strategy was used. CINAHL, Medline, Web of Science, IEEE Xplore Digital Library, and the Cochrane Library databases were screened in from December 2012 to March 2013 to identify studies exploring IVR therapies as an intervention to assist in the management of pain. Main outcome measures were for acute pain and functional impairment. Results:Seventeen research studies were included in total including 5 RCTs, 6 randomized crossover studies, 2 case series studies, and 4 single-patient case studies. This included a total of 337 patients. Of these studies only 4 had a low risk of bias. There was strong overall evidence for immediate and short-term pain reduction, whereas moderate evidence was found for short-term effects on physical function. Little evidence exists for longer-term benefits. IVR was not associated with any serious adverse events. Discussion:This review found moderate evidence for the reduction of pain and functional impairment after IVR in patients with acute pain. Further high-quality studies are required for the conclusive judgment of its effectiveness in acute pain, to establish potential benefits for chronic pain, and for safety.
Role of surgical thoracic sympathetic interruption in treatment of facial blushing: a systematic review

ABSTRACT Objectives: This paper aims to review the evidence to support the effectiveness of sympathectomy as a treatment for facial blushing in terms of relief of facial blushing, patient satisfaction, recurrence of blushing, patients regretting treatment and its associated complications. Methods: A systematic search strategy was performed in Ovid-Medline, Embase, Cochrane library and NICE. Studies reporting outcomes of sympathetic interruption in the treatment of facial blushing were retrieved. Results: Nine studies met the inclusion criteria with 1369 patients included in the final analysis. The age range of patients was 8 to 74 years (from 7 studies) with 56% females. Mean follow up was 21 months in 8 studies (range 6 to 30 months). The pooled proportion of patients who had good relief of facial blushing was 78.30% (95% C.I. 58.20% – 98.39%). Complete satisfaction was reported in 84.02% (95% C.I. 71.71% – 96.33%). Compensatory sweating and gustatory sweating were the commonest complications occurring in 74.18% (95% C.I. 58.10% – 90.26%) and 24.42% (95% C.I. 12.22% – 36.61%) respectively. The estimated proportion of patients regretting surgery was 6.79% (C.I 2.08% 11.50%). Conclusion: Sympathetic interruption at T2 or T2-3 ganglia appears to be an effective treatment for facial blushing. However, lack of randomized trials comparing sympathetic interruption with non-surgical methods of treatment and heterogeneity of included studies with respect to assessment of outcome measures preclude strong evidence and definitive recommendations.
Association between triglyceride/high-density lipoprotein ratio and hearing impairment in a Korean population

ABSTRACT Objective: The aim of the present study was to evaluate the clinical association between triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio and hearing impairment in a Korean population. Patients and methods: This was a cross-sectional study (n = 18,004). Participants were divided into 4 quartiles based on their TG/HDL-C ratio: first quartile (1Q), second quartile (2Q), third quartile (3Q), and fourth quartile (4Q). The threshold values at 0.5, 1, and 2 kHz were averaged to obtain the low- or mid-frequency pure-tone average (Low/Mid-Freq), and the values at 3, 4, and 6 kHz were averaged to obtain the high-frequency pure-tone average (High-Freq). The average hearing threshold (AHT) was calculated as the pure-tone average of the thresholds at 0.5, 1, 2, and 3 kHz. Hearing loss (HL) was defined as an AHT of >40 dB. Results: The Low/Mid-Freq, High-Freq, and AHT values were the highest among participants in 4Q than among those in the other quartiles. Compared with those in 1Q, 2Q, or 3Q, participants in 4Q exhibited a 1.32, 1.27, and 1.16-fold higher odds for HL, respectively. Partial correlation coefficients for TG/HDL-C ratio were 0.065 for Low/Mid-Freq, 0.041 for High-Freq, and 0.060 for AHT (P < 0.001 for all). Linear regression analyses showed that β ± SE for TG/HDL-C ratio was 0.293 ± 0.038 on multivariate analysis. In addition, all subgroup analyses except diabetes participants showed statistically significant association between TG/HDL-C ratio and HL. Conclusion: High TG/HDL-C ratio was associated with hearing impairment in a Korean population.
Spinal Cord Stimulation for Refractory Angina Pectoris

Objectives: Paresthesia-free stimulation such as high frequency and burst have been demonstrated as effective therapies for neuropathic pain. The aim of this meta-analysis was to evaluate the efficacy and safety of conventional spinal cord stimulation (SCS) in the treatment of refractory angina pectoris (RAP). Materials and Methods: Relevant randomized controlled trials that investigated SCS for patients with RAP were comprehensively searched in Medline, Pubmed, Embase, and Cochrane Library. Five meta-analyses were performed examining the changes in Canadian Cardiovascular Society classes, exercise time, Visual Analog Scale (VAS) scores of pain, Seattle Angina Questionnaire, and nitroglycerin use in RAP patients after SCS therapy. We analyzed standardized mean differences (MD) and 95% confidence intervals (CIs) for each outcome by Review Manager 5.0 and STATA 12.0. Results: A total of 12 randomized controlled trials involving 476 RAP patients were identified. A trend of reduction in the angina frequency (MD=−9.03, 95% CI, −15.70 to −2.36) and nitroglycerin consumption (MD=−0.64, 95% CI, −0.84 to −0.45) could be observed in the SCS group. Compared with the control group, SCS showed benefit on increasing exercise time (MD=0.49, 95% CI, 0.13-0.85) and treatment satisfaction (MD=6.87, 95% CI, 2.07-11.66) with decreased VAS scores of pain (MD=−0.50, 95% CI, −0.81 to −0.20) and disease perception (MD=−8.34, 95% CI, −14.45 to −2.23). However, the result did not reach the significance level in terms of physical limitation (95% CI, −8.75 to 3.38; P=0.39) or angina stability (95% CI, −7.55 to 3.67; P=0.50). Discussion: The current meta-analysis suggested that SCS was a potential alternative in the treatment of PAP patients. Further investigation for finding the appropriate intensity of stimulation is required before this treatment should be widely recommended and applied.