Miracle-dz/UniFAR-FTUs huggingface dataset:
Enfermeria basada en la evidencia

The professional nurse of the twenti first century faces challenges of remaining up dated with the scientific and technological advances producing a great impact on the care as an important member of on interdisciplinary health group The work of a nurse demands special training to achive quality health improvement programs interdisciplinary health groups, social security changes, job market requeriments and informatic among others. Besides nursing requires, in this century, fast and dynamic training that allows efficient adjustments to the constant world changes and to provide care based on experience and scientific evidence that can be easily obtained through widespread accesss to the web. The professional nurse must be ahead of the scientific knowledge obtained from the biomedical technology, acquiring information and planning strategies that strengthen the body of knowledge of the care and prevent nursing form being considered as just a technical job. The professional nurse, whatever their area of expertise, should be able to identify the potential and real personal problems affecting their patients, family and community to apply knowledge based on valid and reliable scientific studies
The prognostic significance of tricuspid valve regurgitation in pulmonary arterial hypertension

Tricuspid valve regurgitation (TR) is a frequent finding in patients with pulmonary arterial hypertension (PAH). However, its prognostic significance and relation to PAH, while suspected, are poorly understood. We assessed 727 consecutive patients with newly diagnosed PAH who underwent transthoracic echocardiographic evaluation of tricuspid valve function.
Extrahepatic portal vein obstruction in children: Etiology, treatment and long-term outcome

Objective: Extrahepatic portal vein obstruction (EHPVO) is a common cause of portal hypertension in children. Informative data about this disease in Thai children is still limited. The objective is to study etiology, clinical presentation, investigation, treatment, result and long-term outcome. Material and Methods: The medical records of patients aged less than 15 years with diagnosis of EHPVO at Siriraj Hospital from 1993 to 2013 were retrospectively analyzed. Results: There were 22 children(13 males and 9 females) with median age at diagnosis 5.1 years. The etiology was idiopathic in more than 50%. The patients had umbilical vein catheterization at least 27.2%. The presenting symptoms were splenomegaly 54.5% and upper gastrointestinal bleeding 45.5%. Doppler ultrasonography showed positive results in 52.6%. Initial endoscopic finding showed esophageal varices (EV) grade I 27.3%, grade II 36.3%, grade III 31.8%,and gastric varices (GV) 4.6%. The indications for endoscopic interventions were primary prophylaxis 30%, secondary prophylaxis 40% and stopping GI bleeding 30%. The interventions included endoscopicsclerotherapy (EST) in 6cases, esophageal variceal ligation (EVL)in 6cases, both in7 cases and glue injection in 1 case.Rebleedingoccurred in 50% of secondary prophylaxis and bleeding groups, but none inthe primary prophylaxis group. Patients were followed up for a median of 5.3 years. For long term follow-up, massive splenomegaly andhypersplenism were the major concerns. Surgical treatment included splenectomy (3 cases) and distal splenorenal shunt (1 case). None of the patients died from complications. Conclusion: The etiology ofEHPVO is unknown in the majority of patients. SCT and EVL had success to control and prevent varicealbleeding and eradicate varices. There is an unsettled issue about management of EHPVO after control acute bleeding. Currently, Meso-Rex bypass and distal splenorenal shunt are proposed to be the recommended treatment for suitable cases with reported success in both eradicating varices and control hypersplenism albeit preserving the spleen. Keywords: Portal hypertension, hypersplenism. sclerotherapy, esophageal banding
STUDY OF THE RELATIONSHIP BETWEEN HOPEFULNESS AND SELF- ESTEEM IN RENAL TRANSPLANT RECIPIENTS AT IMAM REZA HOSPITAL, MASHHAD, IRAN, 2002-03

هدیکچ رضاـح شــ هوژپ زا فده دوشیم نامرد هیلک دنویپ ای و زیلاید هلیسو هب هک تسا جیار یاهیرامیب زا یکی هیلک نمزم ییاسران : همدقم دـشابیم دهـشم رهـش رد ، (ع)اضر ماما ناتسرامیب هیلک دنویپ شخب رد هیلک دنویپ هدنریگ نایوجددم رد سفن تزعو دیما طابترا نییعت . تسا هدش ماجنا 1381-1382 یاهلاس یط هک هیلک دنویپ شخب رد هک هیلک دنویپ هدنریگ نایوجددم زا رفن 80 یور رب هک هدوب یگتسبمه ـ یفیصوت عون زا هعلاطم نیا : یسررب شور اههداد یروآدرگ رازبا . تفرگ تروص فده رب ینتبم شور هب یریگ هنومن . تسا هتفرگ ماجنا دناهدش یرتسب (ع) اضر مام ا ناتسرامیب نـییعت تهج . دوب «تیمسا رپوک» سفن تزع شجنس زاربا و «ثره» دیما صخاش ،یدرف تاصخشم همانشسرپ ،هنومن باختنا مرف لماش یـملع دامتعا و رابتعا . دش هدافتسا ددجم نومزآ زا «ثره» دیما صخاش ینایاپ نییعت تهج و یوتحم ییاور شور زا رازبا یملع رابتعا . دندش لیلحت و هیزجت یطابنتسا و یفیصوت رامآ زا هدافتسا اب اه هداد . تسا هدیسر دییأت هب یسین طسوت تیمسارپوک سفن تزع رازبا و تـبثم هـطبار سـفن تزـع و دـیما نازیـم نـیب و دـندوب نییاـپ دـیما حطس یاراد ( دصرد 45) اهدحاو تیرثکا شهوژپ نیا رد : جیاتن طاـبترا دـیما نازیـم اـب یـنید فیلاکت ماجنا نیب یسررب دروم یاهریغتم نیب زا نینچمه ، (r= 0/84و P= 0/0001 ) دش هدید یرادینعم . دنتشادن دیما نازیم رب یرادینعم ریثأت اهریغتم ریاس یلو دش هدید تبثم و رادینعم ســفن تزع شیازفا اب هک دندوب رادروخرب ینییاپ دیما حطس زا هیلک دنویپ هدنریگ نارامیب شهوژپ نیا یاههتفای ساسا رب : یریگ هجیتن . دش اهنآ رد دیما حطس یاقترا ثعاب ناوت یم نارامیب یارب دیما تیمها حیضوت و ینید تاداقتعا تیوقت و
Defining diastolic heart failure and identifying effective therapies.

In this issue of JAMA, Edelmann and colleagues1 report the results of the first substantial randomized, placebo-controlled study investigating the effects of a mineralocorticoid antagonist (MRA), spironolactone, on cardiac function and exercise capacity in patients diagnosed as having heart failure with preserved ejection fraction (HFpEF). The Aldo-DHF trial included 422 patients (mean age, 67 years; 52% women) with chronic, stable symptoms attributed to heart failure, a left ventricular ejection fraction (LVEF) of at least 50%, echocardiographic evidence of LV diastolic dysfunction or atrial fibrillation, and a peak exercise oxygen consumption of 25 mL/kg/min or less during bicycle exercise. Most patients were receiving treatment for hypertension, including thiazide diuretics.1 After 12 months, patients assigned to spironolactone had lower cardiac filling pressures and LV mass, but this did not translate into improved symptoms or exercise capacity. Spironolactone was associated with a slight decline in glomerular filtration and hemoglobin concentration but not with marked hyperkalemia. Only 1 patient died during follow-up.
Reliability of isokinetic concentric and eccentric knee and elbow extension and flexion in 9/10 year old boys

The aim of this study was to determine the reliability of measures of concentric and eccentric extension and flexion peak moment of the knee and elbow of prepubertal boys. Twenty boys volunteered for the study. Ten performed the knee test and ten performed the elbow test. All subjects were permitted a separate day familiarisation session and were later tested on two separate occasions, exactly 1 week apart, at the same time of day and with the same test administrators. Peak moment was measured with an adapted Biodex System-3 using continuous concentric-concentric and eccentric-eccentric cycles at 30°/s and 180°/s. The reliability measures were intraclass correlation coefficient (ICC), repeatability coefficient (RC), limits of agreement (LOA) and coefficient of variation (CV). ICCs ranged from 0.55 to 0.97 and CV ranged from 4% to 15%. There was no systematic difference in peak moment between test and retest. The various indices demonstrated moderate to high reliability of peak moment measurements in this age group which compared favourably with the existing literature. The results of the study support the reliability of measures of concentric and eccentric peak moment in studies of children's strength.
Tacrolimus plus mycophenolate mofetil vs. cyclosporine plus everolimus in deceased donor kidney transplant recipients: three‐yr results of a single‐center prospective clinical trial

We compared in kidney transplantation two immunosuppressive regimens: tacrolimus plus mycophenolate mofetil (MMF) (TAC) and everolimus plus low‐dose cyclosporine (EVE). Sixty consecutive patients received TAC (30 patients) or EVE (30 patients) as immunosuppressive regimen; all subjects also received induction with basiliximab and corticosteroids. After three‐yr follow‐up, no difference was found in patient and graft survival (PTS: TAC: 97% vs. EVE: 100%; GS: TAC: 93% vs. EVE: 93%). The incidence of acute rejection was higher in the EVE group but the difference was not statistically significant (17% vs. 23%, p = ns). Patients in EVE showed higher serum cholesterol (205 ± 41 vs. 235 ± 41 mg/dL, p = 0.0012) and lower hemoglobin concentration (13.6 ± 1.4 vs. 12.4 ± 1.9, p = 0.01). Renal function was not significantly different in the two groups (3 Y creatinine: TAC 1.4 ± 0.8 vs. EVE 1.6 ± 0.8 mg/dL, p = ns). Treatment discontinuation was higher in the EVE group (TAC 17 vs. EVE 36%, p = ns). Our data show that in the middle‐term follow‐up, an immunosuppressive regimen with tacrolimus plus MMF has a similar efficacy and safety profile in comparison with the combination of low‐exposure cyclosporine plus everolimus. Further follow up could evidence the benefits related to the anti‐proliferative effects of everolimus.
Polymorphisms of Interleukin 13 (IL13) in Local Asthmatic Population

Asthma is a chronic inflammatory disorder characterized by wheezing, breathlessness, chest tightness and cough. The inflammation is responsible for bronchial hyperresponsiveness which renders the patient susceptible to certain environmental stimuli. The environmental factors alone are not responsible for these changes as they have an intricate interaction with genetic factors. In this study we determined the spectrum of symptoms and their correlation with serum IgE levels in asthmatic patients since no such data could be found for indigenous population. Cortisol and ACTH levels were determined to ascertain the status of hypothalamic pituitary adrenal axis. Interleukin 13 gene polymorphisms and their association with asthma and serum IgE levels were investigated. For the present study a detailed history was taken and peak expiratory flow measured on 164 asthmatic and 50 controls. Seventy five randomly selected patients underwent serology and SNP genotyping. Serum was analyzed for total IgE, cortisol and ACTH levels. Six SNPs of interleukin 13 gene were studied by PCR-RFLP. Four polymorphisms were from the promoter region C-1512A, T-1112C, A-646G and C-469T, one nonsynonymous polymorphism from the exon 4 A2044 G (Arg toGln) and a 3’UTR polymorphism A2525G. The results of this research revealed that majority of patients belonged to moderate intermittent to severe persistent group. Exposure to dust was the most common triggering factor in our population. Serum IgE levels were directly proportional to the severity of asthma and were significantly correlated with history of allergy. However, no correlation was found between IgE levels and family history of asthma. Adrenal functions were normal when compared with the control group. Two SNPs T-1112C and A2044G showed strong association with serum IgE levels and both the presence and the severity of asthma. C-1512A showed association with asthma and its severity and was the only polymorphism that showed an association with the family history of asthma. While A2525G had a weak association with serum IgE levels only. The other two polymorphisms were in very low frequency in our population and hence no association with phenotypes could be ascertained. It could be concluded from the present investigation that exposure to dust could be the most common precipitating factor of asthma in our population. The two previously studied SNPs T-1112C and A2044G are strongly associated with serum IgE levels and both presence and severity of asthma in our population sample.
Physical activity, fitness level and health problems of healthcare workers in South Africa : the transtheoretical model as an explanatory framework : physical activity and fitness

The aim of this study was to determine the level of physical activity of healthcare workers using the transtheoretical model (TTM) as a framework and to identify barriers to exercise. A self-administered questionnaire was distributed to 200 randomly selected hospital staff members in South Africa. The weight and height of the participants were measured, and fitness level was measured using a step test. The results were analysed using SPSS version 17.0. Approximately 10% of the male and 65% of the female hospital staff were found to be obese or severely obese. Furthermore, 55% of the older staff members were obese compared with 32% of the younger staff members and 44% of the medical staff met the criteria for obesity, which was somewhat less than the 50% of the non-medical staff who were obese. With approximately 25% of the hospital staff reporting that they engaged in regular exercise and/or physical activity, the majority of the staff were found not to engage in regular physical activity. Of those who claimed to engage in regular exercise, the majority were male members of the medical staff who were under 40 years of age and of normal weight. The barriers to exercise ranged from a lack of motivation (>80%), no support at work (>80%), lack of family support (>50%), and lack of facilities at home (45%). The majority of the staff were at the pre-action stages for exercise and displayed low levels of physical fitness, irrespective of their job category. There is, therefore, a need for worksite intervention to improve the level of physical activity of healthcare workers in South Africa. The use of the TTM to identify the appropriate stage of physical activity for healthcare workers will enable health promoters to design programmes specific to the individual's stage of exercise readiness.
2005 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel

Abstract : This report presents the primary results of the 2005 Department of Defense (DoD) Survey of Health-Related Behaviors among Active Duty Military Personnel. This study is the 9th in a series of surveys of active-duty military personnel conducted in 1980, 1982, 1985, 1988, 1992, 1995, 1998, 2002, and 2005 under the direction of the Office of the Assistant Secretary of Defense (Health Affairs). All of the surveys investigated the prevalence of alcohol use, illicit drug use, and tobacco use, as well as negative consequences associated with substance use. The 1985 through 1992 surveys also covered an expanded set of health behaviors and related issues. In 1995 and 1998, health behavior questions were revised and items were added to assess selected "Healthy People 2000" objectives. In addition, questions were added to examine the mental health of the active force, specific health concerns of military women and military men, oral health, and gambling behaviors. The 2002 and 2005 surveys continued the general focus of the 1998 survey and expanded it to include "Healthy People 2010" objectives. They also augmented the items on exercise, nutrition, and mental health and added new items on dietary supplement use, risk taking and impulsive behavior, job satisfaction, deployment, and religiosity/spirituality. The final sample consisted of 16,146 military personnel (3,639 Army, 4,627 Navy, 3,356 Marine Corps, and 4,524 Air Force) who completed self-administered questionnaires anonymously. Following an introductory chapter, chapters are as follows: (2) Methodology of the 2005 DoD Active Duty Survey; (3) Overview of Trends in Substance Use and "Healthy People 2010" Objectives; (4) Alcohol Use; (5) Illicit Drug Use; (6) Tobacco Use; (7) Healthy Lifestyles and Disease Prevention; (8) Health Behavior and Health Promotion; (9) Stress and Mental Health; and (10) Other Health-Related Issues in the Military. The report includes 137 tables.
Animal Rights and Human Morality

Bernard Rollin is an academic philosopher, and he approaches his subject as good philosophers do—identifying critical questions, explicating their meanings, and pondering their implications. Animal Rights and Human Morality is about whether animals have moral and legal rights, particularly in the area of medical research. This is not an easy issue to tackle, nor one devoid of confusion. The author makes an interesting and erudite case for such rights and the need to recognize them, drawing on a wide variety of sources, including Kant, theories of animal awareness, moral theory, and law. His arguments are followed by a section on supposed abuses of animals used for research purposes. At issue are the practical demands of medical research set against animals' rights. A book as broad ranging as this one cannot hope to achieve all its objectives in 182 pages. But some things are clear. The author considerably broadens our awareness
Long‐term dosing patterns of enteric‐coated mycophenolate sodium or mycophenolate mofetil with tacrolimus after renal transplantation

MORE was a four‐yr, prospective, observational study at 40 transplant centers in the US. Data were analyzed to evaluate changes in mycophenolic acid (MPA) dosing over time in 904 de novo kidney transplant recipients receiving enteric‐coated mycophenolate sodium (EC‐MPS, n = 616) or mycophenolate mofetil (MMF, n = 288) with tacrolimus. Induction therapy and steroid treatment were similar in the two subpopulations. The proportion of patients receiving the maximal recommended MPA dose was 80.5%, 43.9%, 39.2%, 34.6%, and 30.1% at baseline and years 1, 2, 3, and 4, respectively. More patients received the maximal recommended MPA dose with EC‐MPS vs. MMF at month 1 (79.2% vs. 71.7%, p = 0.016), month 3 (68.5% vs. 56.9%, p = 0.001), and month 6 (52.9% vs. 44.0%, p = 0.028). Multivariate analysis showed the risk of biopsy‐proven acute rejection, graft loss or death to be similar for EC‐MPS vs. MMF. Estimated glomerular filtration rate (GFR) was similar with EC‐MPS vs. MMF at all time points. There were no significant differences in any category of adverse event between the EC‐MPS and MMF cohorts during follow‐up, including gastrointestinal events. In conclusion, MPA dose was maintained more effectively in the first six months after kidney transplantation using EC‐MPS vs. MMF, without an increase in adverse events.
Applications of hybrid diffuse optics for clinical management of adults after brain injury

Information about cerebral blood flow (CBF) is valuable for clinical management of patients after severe brain injury. Unfortunately, current modalities for monitoring brain are often limited by hurdles that include high cost, low throughput, exposure to ionizing radiation, probe invasiveness, and increased risk to critically ill patients when transportation out of their room or unit is required. A further limitation of current technologies is an inability to provide continuous bedside measurements that are often desirable for unstable patients. Here we explore the clinical utility of diffuse correlation spectroscopy (DCS) as an alternative approach for bedside CBF monitoring. DCS uses the rapid intensity fluctuations of near-infrared light to derive a continuous measure of changes in blood flow without ionizing radiation or invasive probing. Concurrently, we employ another optical technique, called diffuse optical spectroscopy (DOS), to derive changes in cerebral oxyhemoglobin (HbO2) and deoxyhemoglobin (Hb) concentrations. Our clinical studies integrate DCS with DOS into a single hybrid instrument that simultaneously monitors CBF and HbO2/Hb in the injured adult brain. The first parts of this dissertation present the motivations for monitoring blood flow in injured brain, as well as the theory underlying diffuse optics technology. The next section elaborates on details of the hybrid instrumentation. The final chapters describe four human subject studies carried out with these methods. Each of these studies investigates an aspect of the potential of the hybrid monitor in clinical applications involving adult brain. The studies include: (1) validation of DCS-measured CBF against xenon-enhanced computed tomography in brain-injured adults; (2) a study of the effects of age and gender on posture-change-induced CBF variation in healthy subjects; (3) a study of the efficacy of DCS/DOS for monitoring neurocritical care patients during various medical interventions such as head-of-bed manipulation and induced hyperoxia; and (4) a first feasibility study for using DCS to study hemodynamics at high altitudes. The work presented in this dissertation thus further develops DCS/DOS technology and demonstrates its utility for monitoring the injured adult brain. It demonstrates the promise of this new clinical tool to help neurocritical care clinicians make more informed decisions and thereby improve patient outcome. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Physics & Astronomy First Advisor Arjun G. Yodh This dissertation is available at ScholarlyCommons: http://repository.upenn. edu/edissertations/768
PROCEEDINGS OF THE HUMAN FACTORS SOCIETY-30th ANNUAL MEETING- 1986 WORK-RELATED BACK INJURIES AMONG NURSING PERSONNEL IN NEW YORK

This paper describes an analysis of workers' compensation data from New York state comparing disabling back injury experiences of: 1) Registered Nurses, Licensed Practical Nurses, nursing aides, and employees in 21 other occupations selected to provide interesting comparisons, 2) groups defined by the three nursing-related occupational categories within four major health care industries, and 3 ) men and women in 18 occupational categories.
Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis

Aims The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study. Methods and results We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses. Conclusion Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity.