Miracle-dz/UniFAR-FTUs huggingface dataset:
Ertapenem compared to combination drug therapy for the treatment of postpartum endometritis after cesarean delivery

Objective: Ertapenem is a broad spectrum carbapenem approved for the treatment of postpartum endometritis. Data regarding clinical outcomes after treatment with ertapenem for endometritis after cesarean delivery are limited. Our objectives were to compare clinical outcomes and cost of ertapenem versus a multi-drug regimen for treatment of endometritis after cesarean delivery. Methods: Retrospectively, patients with endometritis after cesarean delivery who were treated with ertapenem (group A) were compared to those treated with a combination regimen (group B). Mann–Whitney U and Fisher’s Exact were used for statistical analysis with p value <0.05 considered statistically significant. Results: Sixty-three patients were included: 31 in group A and 32 in group B. Demographics and intrapartum characteristics did not differ. Number of administered doses (A: 3, B: 11.5 p < 0.0001), cost (A: $156.63, B: $54.48 p < 0.0001) and nursing time in minutes (A: 6.6, B: 25.3 p < 0.0001) were different between both groups. Wound complications were higher in group A, occurring in 7 patients compared to 1 patient in group B (p = 0.024). Conclusion: Although time and number of administered doses were less in group A, given the high wound complication rate in patients treated with ertapenem, this drug may not be appropriate for all patients with endometritis after CD.
Evidence-based platelet transfusion recommendations in neonates

Even though for certain varieties of neonatal thrombocytopenia, intravenous immunoglobulin or corticosteroids are recommended as treatments, platelet transfusions represent the only specific therapy currently available for most thrombocytopenic neonates in NICUs. The majority of these NICU platelet transfusions, up to 98% in some recent reports, are given to prevent, rather than to treat, bleeding. The trigger limit of platelet count to prophylactically treat non-bleeding patients is generally arbitrary. A complete definition, of the benefits and the risks of prophylactic platelet transfusions in thrombocytopenic neonates is necessary. In fact, there is great variability worldwide in neonatal platelet transfusion practice, due to the lack of concrete evidence to guide transfusion decisions. Evidence-based guidelines do not exist to decide when platelet transfusion should be given. The practice of neonatal platelet transfusions is based almost entirely on expert opinion and reasoning. Consequently, these practices, not supported by definitive data, vary widely. To increase benefits and safety, new widespread changes in platelet transfusion guidelines are necessary. New transfusion paradigms should not be based on reasoning alone, but on important experimental validation. The neonatologists would better accept them and more closely adhere to.
The Direct Program: A Disease/Inflammatory vs Risk Factor Evaluation Cardiovascular Testing Program

The DIRECT Program-Disease/Inflammation vs Risk Evaluation Cardiovascular Testing Program (DIRECT) is a continuing education program developed and delivered to nurse practitioners that addresses the gap in practice between a risk factor approach to cardiovascular assessment and the scientific evidence for a disease/inflammatory approach. The purpose of this article is to describe the DIRECT program, identify the gaps in current guidelines and then describe the process by which the DIRECT program was tested with a group of practicing nurse practitioners. The activity was created after a systemic review of the current clinical guidelines for cardiovascular disease risk assessment presented a comprehensive review of the evidence supporting a disease/inflammatory approach to cardiovascular disease prevention. Following the delivery of the course content, the nurse practitioners were given ample time to discuss the information and they were evaluated for course knowledge and queried about intent to apply the information to practice. Clinical decision making of nurse practitioners completing this activity was assessed using clinical case application of both models (disease and risk). The aim of this program was to promote a health-screening model for family practice nurse practitioners with the goal of preventing heart attacks and ischemic strokes in primary care patients, aimed at quality improvement of care and the application of a new care model for nursing practice. This program celebrates the core foundational calling for doctoral prepared nurses to practice the most advanced level of nursing practice, which involves the application of current scientific knowledge that transcends specialties for the benefit of optimal health for the patient. The results revealed a statistically significant indication that the nurse practitioners felt that DIRECT would enhance their current practice and they felt a disease/inflammatory approach to cardiovascular disease risk assessment was more effective than the standard risk factor model currently in the standard of care.
Revision Hip Arthroplasty with an Extensively Porous-coated Stem - Excellent Long-term Results Also in Severe Femoral Bone Stock Loss

During the last 25 years uncemented hip stem revision relying on diaphyseal fixation has shown improving clinical results and stem survival. The purpose of this study was to present the long-term results of hip revision with the SOLUTION stem (DePuy Warsaw Indiana). Ninety-three consecutive SOLUTION hip stem revisions in 84 patients with a mean age of 69 years (range 33-86 years) were reviewed. Of these, clinical and radiographic follow-up examination by an independent observer was possible in 36 hips/29 patients after mean 14 years (range 10-18 years). Stem re-revision was documented by our own files and by the Danish Hip Arthroplasty Registry. Stem re-revision had been performed in two hips for aseptic loosening, one due to deep infection and in one patient due to stem fracture. The 18 years cumulative survival, free of re-revision for any reason was calculated as 94.4% (88.9-99.8)% and for aseptic loosening to 97.6% (94.3-100%). Intraoperative complications were frequent with incidence of shaft fractures (14/93) and perforations (9/93) showing a significant learning curve. Mean Harris Hip Score was 85 (range 53-99). Osseointegration was seen in 34/36 stems with two stems fibrous fixated. Stress shielding was significant associated with stem diameters ≥15 mm. Severe preoperative bone deficiency had no negative bearing on stem survival and no significant influence on osseointegration of the stem or on Harris Hip Score. Conclusion: Femoral stem revision with an extensively porous-coated monoblock chrome-cobalt stem seems to be a reliable and reproducible technique resulting in excellent long-term survivorship and clinical outcome. It can be used in femurs with deficient bone stock.
Results using Trabecular Metal™ augments in combination with acetabular impaction bone grafting in deficient acetabula

We examined whether the use of trabecular metal wedges to fill segmental defects is an effective method of socket reconstruction when used in combination with impaction grafting and implantation of a cemented socket. Fifteen hips in 14 patients underwent impaction grafting in combination with a TM wedge with a minimum of two years follow-up. All patients had their defects assessed using the Paprosky classification. Patients were reviewed with x-rays and migration of the implant was measured. Outcome scores were also collected. Mean follow-up was 39 months (25-83). The mean age at surgery was 67.8 (49-85) years. Seven of the patients had previously undergone impaction grafting with the use of a stainless steel rim mesh to constrain the graft. None of the patients had failed either clinically or radiologically.
Short Stems in Total Hip Replacement: Current Status and Future

Short stem hip implants have been introduced as a bone preserving surgery for younger and more active people undergoing hip arthroplasty. Although many short stems are now available, clinical results and long-term survival are controversial. The aim of this paper is to describe the features of the short stems and to analyse their clinical results and long-term survival. The short-stem implants reproduce a stress distribution at the level of the proximal femur more similar to the physiological femur limiting the stress-shielding that occur with conventional cementless stems. Though short stems are an alternative to conventional stems, their use is not yet justified despite the promising short and mid-term survival results. Higher incidence of complications, such as periprosthetic fractures and malpositioning of the stem, and the lack of long-term results do not allow to predict what role in the future short stems in total hip replacement may have.
Strategies for reducing the incidence of skin complications in newborns treated with whole-body hypothermia

Objective: To present the results of a strategy designed to reduce the incidence of skin complications in newborns with hypoxic–ischemic encephalopathy treated with moderate whole-body hypothermia. Design: Retrospective study. Setting: Neonatal Intensive Care Unit (NICU). Patients: Thirty-nine neonates cooled in the considered period. Intervention: Starting from January 2008, for neonates treated with moderate whole-body hypothermia (33.5 °C), the cooling system was set in “automatic servo-controlled mode (ACM)”, where the temperature of the circulating water could vary between 4 °C and 42 °C. Starting from January 2009, cooling blankets were used in another type of automatic mode, the “gradient variable mode (GVM)”, where the circulating water was maintained at a specific pre-set gradient towards the patient’s body temperature, and a specific nursing protocol (NP) was adopted. Measurements and main results: Two of the eleven newborns treated with the “ACM” exhibited skin complications compatible with subcutaneous fat necrosis (SFN). None of the twenty-eight newborns treated with the “GVM” exhibited skin complications. A comparison of the biochemical and hematological data between these two groups revealed that newborns treated after the adopting of a NP and the “GVM” showed lower serum protein C and calcium levels, and higher platelet levels. Conclusions: Our data suggest that newborns undergoing therapeutic cooling may benefit from a specific NP and correct cooling unit setting. Should further studies confirm our data, this nursing approach could be easily adopted.
A pilot emperical investigation into student perceptions of service quality at the Department of Management of the University of the Western Cape

This pilot research survey was undertaken as a result of the need to assess the service quality within Higher Education in general and the Department of Management at UWC in particular. This report focuses on the complexities of measuring service quality in higher education. The quality of service delivery within education is becoming more important as the competition for students increases. The literature was searched to find a suitable measure with a sound theoretical structure. This measure was then adapted for the department. In a preliminary way this instrument was then applied to students in the department and initial results are reported on. The results revealed that undergraduates overall were uncertain in their attitude to the service quality in the department. On the other hand, postgraduate students tended to rate the service quality rather more negatively (p < 0.004). Furthermore there were no gender differences except for tangibles (p = 000.5). This pilot study could serve as a pilot study of the service quality in an academic environment. It is the main contention of this report that students themselves should be part of defining quality.
Remission of HCV-associated Glomerulonephritis with Pegylated IFN and Ribavirin Therapy after Liver Transplantation: Case Report and Literature Review

Background Hepatitis C virus infection is associated with a variety of extrahepatic disorders such as membrano-proliferative glomerulonephritis, which is generally due to cryoglobulinemia. Setting We describe the case of one liver transplant recipient who received antiviral therapy (subcutaneous administration of peg-IFN-alpha-2a 180 mcg weekly and oral ribavirin 200 mg thrice a day) for HCV-related membrano-proliferative glomerulonephritis. He presented normal kidney function, non-nephrotic proteinuria (2 g/24 h) and mild hematuria. Results Urinary abnormalities disappeared within a few weeks after the initiation of antiviral therapy; however, combination antiviral therapy was not able to obtain viral clearance. After 11 months, IFN-therapy was interrupted and the patient continued low-dose ribavirin monotherapy (200 mg once per day) for one additional year- remission of proteinuria (<0.3 g/24 h) and hematuria persisted with intact kidney function. Although other mechanisms cannot be excluded, we suggest that ribavirin therapy was critically implicated in the remission of urinary abnormalities in our patient. The existing literature on the association between HCV-associated glomerulonephritis and therapy with ribavirin is reviewed. Conclusions Antiviral therapy may be effective in patients with HCV-induced glomerulonephritis. Further evidence is needed to evaluate efficacy and safety of ribavirin monotherapy for HCV-related glomerulonephritis.
SAT0598-HPR Valued Life Activities: Swedish Version (VLA-SWE) with Cultural Adaptation, ICF Linkage and Psychometric Testing

Background Disability is an important outcome in rheumatoid arthritis (RA). The Valued Life Activity scale (VLA) comprises a wide range of life activities deemed to be important by the individual, ranging from self-care to leisure activities. Thereby VLA takes the patients´ priorities into account and includes activities in which disability may occur early. Objectives Translation, cultural adaptation including linkage to the International Classification of Functioning, Disability and Health (ICF) and psychometric testing of the VLA scale in Swedish patients with RA. Methods The VLA, developed by Katz et al (1) was translated and culturally adapted to a Swedish version, the VLA-swe. As a part of this, both the VLA and VLA-swe were linked to the ICF according to linking rules (2). 737 RA patients(73% women)aged 18 - 80 (mean age 62 years) were recruited from the Swedish Rheumatology Quality Registry (SRQ). The average disease duration was 16 years. Data for disease activity (DAS28), activity limitations (HAQ) and life satisfaction (LiSat11) were registered and patients completed the VLA-swe. Internal consistency was assessed with Cronbach’s alpha and item statistics. To establish construct validity VLA-swe was correlated to DAS28, HAQ and LiSat11. Results The conceptual similarity between the VLA-swe and the original VLA was high when linked to the ICF: in 29 of the 33 items the ICF codes tallied exactly with each other and the remaining differed only slightly. Each of the 9 ICF activity/participation domains was represented in one or more items. The internal consistency was excellent for the VLA-swe (0.97) and alpha coefficients did not improve after omitting any of the 33 items. The correlations between the single items and the total VLA-swe score varied between r=0.57 and r=0.84. Scores of the VLA-swe correlated strongly with the HAQ (r=0.87), moderately with the LiSat11 (r=-0.61) and weakly with the DAS28 (r=0.38), as expected. Conclusions The VLA-swe is culturally adapted and validated, and addresses a broad range of ICF activity/participation domains. Since both the patients´ preferences and ICF concepts of disability are taken into account, it is a useful complement to traditional measures, such as the HAQ, which measure activity limitations only. References Katz P, Morris A, Yelin E. Prevalence and predictors of disability in valued life activities among individuals with rheumatoid arthritis. Ann Rheum Dis 2006;65:763e9. Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun B, Stucki G. ICF linking rules: an update based on lessons learned. J Rehabil Med 2005;37:212-218. Disclosure of Interest None Declared
Gatifloxacin Pharmacokinetics in Healthy Men and Women

The sex‐based pharmacokinetics of gatifloxacin were investigated. Healthy subjects (6 men, 6 women) received a single oral dose of gatifloxacin 400 mg. Blood and urine samples were collected, and gatifloxacin concentrations were determined by high‐performance liquid chromatography. Pharmacokinetic parameters were estimated by fitting appropriate models to the serum concentration‐time data using ADAPT II. Linear regression analysis was used to determine the influence of sex and weight on the oral clearance (CLs/F) and apparent steady‐state volume of distribution (Vss/F) of gatifloxacin. Women had a significantly smaller Vss/F compared to men (93.5 ± 21.3 L vs 128.8 ± 16.2 L, P = .009); however, there was no significant difference when normalized for total body weight (TBW) or lean body weight (LBW). Neither CLs/F nor peak serum concentration (Cmax) was significantly different between sexes, although Cmax was 25% higher in women (P = .06). Regression analyses revealed that TBW (R2 = .63) and LBW (R2 = .65) were strong predictors of Vss/F. Given the smaller Vss/F, women may have slightly higher maximum concentrations, but these differences are unlikely to have clinical significance.
Diferenciais intra-urbanos de vulnerabilidade da população idosa

Foi examinada a adequacao de um Indice de Vulnerabilidade a Saude (IVS) para identificar diferenciais intra-urbanos de vulnerabilidade da populacao idosa. Os participantes do estudo (n = 1.055) foram selecionados por meio de amostra probabilistica de residentes no Municipio de Belo Horizonte, Minas Gerais, Brasil, com mais de 60 anos de idade (media = 70,1 anos). O IVS e composto por medidas das condicoes socioeconomicas e por indicadores da mortalidade precoce do setor censitario. Com base no escore do IVS, o local de residencia dos participantes foi classificado em estrato de riscos baixo, medio e alto. Os resultados da regressao logistica ordinal multivariada mostraram associacoes graduadas e estatisticamente significantes entre o estrato de risco da area de residencia e o ambiente fisico e social, condicoes de saude, comportamentos em saude e necessidades de servicos de saude (razoes de prevalencia variando entre 1,17; IC95%: 1,02-1,34 e 1,65; IC95%: 1,45-1,88). O IVS parece ser um instrumento util para a identificacao de areas com maior necessidade de servicos sociais e de saude entre os idosos.
Statistical Methods for Clinical Trials with Multiple Outcomes, HIV Surveillance, and Nonparametric Meta-Analysis

Central to the goals of public health are obtaining and interpreting timely and relevant information for the benefit of humanity. In this dissertation, we propose methods to monitor and assess the spread HIV in a more rapid manner, as well as to improve decisions regarding patient treatment options. In Chapter 1, we propose a method, extending the previously proposed dual-testing algorithm and augmented cross-sectional design, for estimating the HIV incidence rate in a particular community. Compared to existing methods, our proposed estimator allows for shorter follow-up time and does not require estimation of the mean window period, a crucial, but often unknown, parameter. The estimator performs well in a wide range of simulation settings. We discuss when this estimator would be expected to perform well and offer design considerations for the implementation of such a study. Chapters 2 and 3 are concerned with obtaining a more complete understanding of the impact of treatment in randomized clinical trials in which multiple patient outcomes are recorded. Chapter 2 provides an illustration of methods that may be used to address concerns of both risk-benefit analysis and personalized medicine simultaneously, with a goal of successfully identifying patients who will be ideal candidates for future treatment. Riskbenefit analysis is intended to address the multivariate nature of patient outcomes, while “personalized medicine” is concerned with patient heterogeneity, both of which complicate the determination of a treatment’s usefulness. A third complicating factor is the duration of treatment use. Chapter 3 features proposed methods for assessing the impact of treatment as a function of time, as well as methods for summarizing the impact of treatment across a
Docetaxel, Capecitabine and Concurrent Radiotherapy for Gastric Cancer Patients with Postoperative Locoregional Recurrence

Aims and background This study aimed to assess the efficacy of concurrent chemoradiotherapy (CCRT) with docetaxel and capecitabine versus docetaxel and capecitabine chemotherapy for gastric cancer patients with postoperative locoregional recurrence. Methods From 2008 to 2011, 81 patients with locoregional recurrence after curative resection of gastric cancer were enrolled. Thirty-nine (CCRT group) received involved-field radiotherapy with oral capecitabine (twice daily, 5 days/week) and intravenous infusion of docetaxel (once weekly). The remaining 42 patients (chemotherapy group) were treated with oral capecitabine (twice daily, days 1-14) followed by intravenous infusion of docetaxel (days 1 and 8). The overall response rate, overall symptom control rate, toxicity or adverse reactions, and overall survival (OS) were compared. Results The overall response rate (CR+PR) was significantly higher in the CCRT group (79.5%) than the chemotherapy group (54.8%). In CCRT individuals, the control rates for bleeding, pain, and dysphagia/obstruction were 87.5%, 75%, and 71.4%, respectively, versus 63.2%, 50%, and 28.6% in the chemotherapy group. CCRT patients had a better symptom control rate than the chemotherapy group (52.5% vs. 80%). Adverse reactions were non-significantly more severe in CCRT patients. Finally, median OS was longer in the CCRT vs. chemotherapy group (14.2 vs. 6.4 months). Conclusions Involved-field radiotherapy with docetaxel and capecitabine was effective and well tolerated. These findings provide further insight into the role of CCRT in gastric cancer. However, this was not a randomized controlled study and the number of patients was relatively small, suggesting that cautious interpretation of cumulative estimates is warranted.
REPRODUCTIVE HORMONES AND CORTISOL RESPONSES TO PLYOMETRIC TRAINING IN MALES

Plyometric training activities are commonly used by a wide range of athletes to increase jump performance and improve explosive power and muscular activation patterns. The purpose of the study was to evaluate the effects of plyometric training on male reproductive hormones. Nineteen recreationally active males volunteered to participate in this study and were randomly assigned to plyometrically trained (n=10, 21.2 ±2.3 years) and control groups (n=9, 21.4± 2.1). The plyometric training group performed in a six-week plyometric training programme and the control group did not perform any plyometric training techniques. Resting serum levels of testosterone, prolactin, follicle stimulating hormone (FSH), luteinising hormone (LH), and cortisol were measured in each subject at t0 (before the training), t1 (end of third week) and t2 (end of training). Two-way ANOVA revealed significant (P<0.05) interaction effects for testosterone, prolactin, FSH and cortisol. Six-week plyometric training decreased serum levels of testosterone, cortisol and FSH and increased serum levels of prolactin. These results suggest the presence of alterations in anabolic and catabolic hormonal responses to resistance exercise in men.