Miracle-dz/UniFAR-FTUs huggingface dataset:
Conducta anestésica en la colecistectomía video-laparoscópica de un paciente propuesto para trasplante pulmonar

Introduction: videolaparoscopic surgical treatment of gallstone disease reduces hospital stay to a minimum and makes it possible to treat many of the cases on an outpatient basis. Objective: describe the clinical evolution of a patient with severe chronic obstructive pulmonary disease (COPD) proposed for lung transplantation. Clinical case: 55-year-old male patient diagnosed with gallstone disease, inveterate smoker with severe COPD and Hodgkin lymphoma. The physical examination revealed diminished vesicular murmur, sibilants, tachypnea and active use of accessory neck muscles for breathing. Surgical time was 1 hour 20 minutes. Recovery was satisfactory. Jaundice was observed on the third day of the postoperative period. Abdominal ultrasonography revealed dilatation of the main bile duct, and emergency endoscopic retrograde cholangio-pancreatography performed under general intravenous anesthesia showed a lesion on the main bile duct. It was decided to perform an hepaticojejunostomy by conventional surgery under combined anesthesia (continuous epidural-general orotracheal). After transfer to the postoperative care unit, the patient remained intubated with a view to his recovery and eventual followup, and was discharged from hospital 21 days after his first surgery exhibiting a satisfactory evolution. Conclusions: minimally invasive surgery may be used in patients with severe COPD as long as it is closely watched and the following requirements are met: anesthesia with stability of all systems, adequate perioperative surveillance, pain control and recovery in specialized postoperative care units.
Comparing Virtual Reality Exposure Therapy to Prolonged Exposure in the Treatment of Soldiers with PTSD

Abstract : Prolonged exposure (PE) is one of the most researched psychotherapies for PTSD. Virtual reality exposure (VRE) has demonstrated growing support as an innovative method for activating the trauma memory during exposure. However, there is limited research on the effectiveness of either treatment with active duty military personnel and there are no head-to-head clinical trials. Soldiers with PTSD from deployments to Iraq or Afghanistan (N = 162) were randomized to 10 sessions of either PE or VRE or were assigned to a minimal attention wait list. All assessments were conducted by a psychologist blind to treatment group. External, independent treatment fidelity reviews were conducted for both treatments. Service members were assessed before randomization, after 5 sessions, at posttreatment, and 3-and 6-months posttreatment. PTSD was assessed with the Clinician Administered PTSD Scale (CAPS). Data were analyzed at the end of the performance period for this study but prior to the end of the period of performance for another grant/recruitment site. Results indicated significant improvement in symptoms for PE and VRE relative to the waitlist control. Contrary to expectations, PE demonstrated greater PTSD symptom reduction relative to VRE, which was statistically significant at the 12-week follow-up assessment. These findings extend previous findings on the efficacy of exposure therapy to an active duty military population and highlight important areas for future research of VRE.
Factores de riesgo epidemiológico de hepatitis C en pacientes hemodializados

Se hizo un estudio descriptivo y transversal de 44 pacientes con insuficiencia renal cronica en fase terminal, atendidos en el Servicio de Hemodialisis del Hospital Orlando Pantoja Tamayo del municipio de Contramaestre desde junio de 2004 hasta igual mes de 2009, con vista a identificar algunos factores epidemiologicos favorecedores de la aparicion de hepatitis C. En la serie primaron el sexo masculino, el grupo etareo de 40 a 49 anos y la diabetes sacarina, esta ultima como causa fundamental de la enfermedad. Los portadores de hepatitis C fueron transfundidos y tratados con hemodialisis por mas tiempo que aquellos hemodializados que no padecian la citada infeccion. Entre los factores de riesgo para presentar esa inflamacion del higado figuraron, entre otros, prolongacion de la hemodialisis y ejecucion de transfusiones sanguineas frecuentes. (AU) A descriptive and cross-sectional study of 44 patients with chronic kidney failure in terminal stage was carried out. They were assisted in the Hemodialysis Service of the Orlando Pantoja Tamayo Hospital of Contramaestre municipality from June, 2004 to June, 2009, in order to identify some epidemiologic factors that favor the emergence of hepatitis C. In the series prevailed the male sex, the age group from 40 to 49 years and type I diabetes mellitus, the latter as fundamental cause of the disease. The hepatitis C carriers were transfused and treated with hemodialysis for more time than those hemodialyzed that didn't suffer from the infection. Among the risk factors to present that liver inflammation are included, among others, hemodialysis elongation and implementation of frequent blood transfusions. (AU)
Lost without translation: Selective Control Assessment of the Lower Extremity (SCALE) in German

As clinicians and scientists, translation is an important concept. We translate the meaning of words to students, patients, and families. We have been challenged to translate scientific evidence into practice. When publishing consensus definitions, classifications, evaluations, and outcomes, English language nuances across countries and continents must be considered. During meetings of the Taskforce on Childhood Motor Disorders, we spent hours deliberating the optimal words to define various motor impairments, including reduced selective motor control and obtaining consensus among a diverse group of clinicians and researchers – not an easy task. In developing content validity for Selective Control Assessment of the Lower Extremity (SCALE), we learned that facilitating plantar flexion by coaching a child to move as if they were pushing on a ‘gas pedal’ was not logical in a country that uses ‘petrol’. Balzer et al. translated the English version of SCALE into German for use in the clinical environment. Although, I cannot directly evaluate this translation, the methods used instill confidence in their findings. International guidelines for translation of clinical measures were followed. The authors assessed the validity and reliability of the translated version for children with spastic cerebral palsy for which SCALE was designed. The original published SCALE validation results were supported and expanded. Additional validation was performed using the Fugl-Meyer Assessment, which includes evaluation of isolated joint motion. Some limitations were noted. The concentration of participants in Gross Motor Function Classification System level I limits the generalization of their results to children with lower mobility levels. Additionally, this study demonstrated the reliability of scoring but did not address the reliability of administration as all tests were scored from videotaped assessments. Hopefully, the German version of SCALE will fully translate into the clinical environment. As the American Academy for Cerebral Palsy and Developmental Medicine, European Academy of Childhood Disability, and the Australasian Academy of Cerebral Palsy and Developmental Medicine move toward an international alliance that supports clinicians in developing countries, translation must consider not only the meaning of the words but also the values present in diverse cultures.
A retrospective study on the incidence and risk factors of severe hypoglycemia in primary care.

AIMS To investigate the incidence and risk factors of severe hypoglycemia (SH) in primary care. SH was defined as hypoglycemia with coma, or the need of glucose or glucagon injection. METHODS We performed a cross-sectional retrospective study in patients with diabetes treated in primary care in Germany. We analyzed an unselected sample of participants with type 1 (n = 373) and type 2 diabetes (n = 4481) who participated in an insurance plan from the health care insurer Deutsche BKK. Data of participants with type 1 diabetes are as follows: women, n = 155 (42%); age, 49±16 years; diabetes duration, 20+13 years; BMI, 28±6 kg/m2; GHb, 7.1+1.5%; GHb≤7%, n = 263 (71%); GHb≥8.5%, n = 48 (13%). Data of participants with type 2 diabetes: women, n = 1979 (44%); age, 66±10 years; diabetes duration, 8±7 years; BMI, 30±5 kg/m2; GHb, 6.6±1.3%; GHb≤7%, n = 3747 (84%); GHb≥8.5%, n = 360 (8%); insulin therapy, n = 1175 (26%). RESULTS The incidence of SH in type 1 diabetes: 1.3% (CI: 0.4%, 3.1%) per year; type 2 diabetes with insulin therapy: 0.9% (CI: 0.5%, 1.7%); without insulin therapy: 0.3% (CI: 0.1%, 0.6%). The event rate was 0.02 SH per patient/year in type 1 diabetes and 0.01 in type 2 diabetes, respectively. Low BMI, GHb, insulin therapy and female gender were associated with an increased risk of SH. CONCLUSIONS In primary care, patients with diabetes can achieve good glycemic control with very rare events of SH. Due to low incidence, SH would have been an inappropriate parameter to evaluate the outcome quality of diabetes therapy in primary care.
Patient perceptions of barriers to the early diagnosis of lung cancer and advice for health service improvement.

BACKGROUND AND OBJECTIVE Patient and systematic factors within primary and secondary care contribute to delay in timely diagnosis of lung cancer. This qualitative study aimed to explore New Zealand service users' experiences of the pathway to lung cancer diagnosis, identify factors contributing to delay and provide advice for service improvement. METHODS Two samples were recruited. Patients who presented to a hospital emergency department with suspicious symptoms (n = 19) were interviewed individually. Those with confirmed lung cancer (n = 20) took part in a focus group. Similar semi-structured interview schedules were used. Interviews and focus groups were audiorecorded and thematic analyses performed. Evident commonality led to an integrated interpretation. RESULTS Patient delay was common but most had seen a GP before referral. No ED participant had seen a respiratory specialist prior ED admission, but after that, most had a seamless pathway. This contrasts with long waits for outpatient participants. Two central themes, 'access to health services' and 'processes of care', described factors influencing delay. Subthemes highlighted issues relating to symptom interpretation, health beliefs, provider continuity, relationships and perceived expertise that contributed to patient and GP delay. System complexity, information systems and resourcing issues were identified as barriers at the primary-secondary care interface and within secondary care. CONCLUSION Reasons for diagnostic delay are complex and multifactorial. Solutions include community initiatives to educate and resource at-risk patients to seek help, supporting and resourcing primary care to increase timely referral and implementing strategies to reduce system complexity for GPs and patients, and the employment of care coordinators.
Prevalence of cerebral amyloid pathology in persons without dementia: a meta-analysis.

IMPORTANCE Cerebral amyloid-β aggregation is an early pathological event in Alzheimer disease (AD), starting decades before dementia onset. Estimates of the prevalence of amyloid pathology in persons without dementia are needed to understand the development of AD and to design prevention studies. OBJECTIVE To use individual participant data meta-analysis to estimate the prevalence of amyloid pathology as measured with biomarkers in participants with normal cognition, subjective cognitive impairment (SCI), or mild cognitive impairment (MCI). DATA SOURCES Relevant biomarker studies identified by searching studies published before April 2015 using the MEDLINE and Web of Science databases and through personal communication with investigators. STUDY SELECTION Studies were included if they provided individual participant data for participants without dementia and used an a priori defined cutoff for amyloid positivity. DATA EXTRACTION AND SYNTHESIS Individual records were provided for 2914 participants with normal cognition, 697 with SCI, and 3972 with MCI aged 18 to 100 years from 55 studies. MAIN OUTCOMES AND MEASURES Prevalence of amyloid pathology on positron emission tomography or in cerebrospinal fluid according to AD risk factors (age, apolipoprotein E [APOE] genotype, sex, and education) estimated by generalized estimating equations. RESULTS The prevalence of amyloid pathology increased from age 50 to 90 years from 10% (95% CI, 8%-13%) to 44% (95% CI, 37%-51%) among participants with normal cognition; from 12% (95% CI, 8%-18%) to 43% (95% CI, 32%-55%) among patients with SCI; and from 27% (95% CI, 23%-32%) to 71% (95% CI, 66%-76%) among patients with MCI. APOE-ε4 carriers had 2 to 3 times higher prevalence estimates than noncarriers. The age at which 15% of the participants with normal cognition were amyloid positive was approximately 40 years for APOE ε4ε4 carriers, 50 years for ε2ε4 carriers, 55 years for ε3ε4 carriers, 65 years for ε3ε3 carriers, and 95 years for ε2ε3 carriers. Amyloid positivity was more common in highly educated participants but not associated with sex or biomarker modality. CONCLUSIONS AND RELEVANCE Among persons without dementia, the prevalence of cerebral amyloid pathology as determined by positron emission tomography or cerebrospinal fluid findings was associated with age, APOE genotype, and presence of cognitive impairment. These findings suggest a 20- to 30-year interval between first development of amyloid positivity and onset of dementia.
CLINICAL PRACTICE. Advanced Dementia.

An 89-year-old male nursing home resident with a 10-year history of Alzheimer’s disease presents with a temperature of 38.3°C, a productive cough, and a respiratory rate of 28 breaths per minute. Nurses report that for the past 6 months he has been coughing at breakfast and having trouble swallowing. He has profound memory deficits, no longer recognizes his daughter (who is his health care proxy), is bedbound, is able to mumble a couple of words, and is unable to perform any activities of daily living. The nurse asks whether he should be hospitalized. How should this patient be evaluated and treated?
Subclinical Hyperthyroidism

SUBCLINICAL HYPERTHYROIDISMSubclinical hyperthyroidism, in which serum thyroid hormone levels are within the reference range but serum thyrotropin levels are subnormal (≤0.4 mU per liter), may be caused by overproduction of endogenous thyroid hormone or excessive ingestion of exogenous thyroid hormone.Progression to overt hyperthyroidism may occur, especially when serum thyrotropin levels are less than 0.1 mU per liter.Even without progression to overt hyperthyroidism, subclinical hyperthyroidism can be associated with adverse outcomes, including cardiovascular disease (e.g., atrial fibrillation, heart failure, and coronary heart disease), bone loss, fractures, and dementia, particularly in persons older than 65 years of age with severe disease.Although data are lacking from randomized clinical trials to guide treatment decisions, professional organizations recommend treatment of subclinical hyperthyroidism in persons older than 65 years of age and postmenopausal women, especially when serum thyrotropin levels are less than 0.1 mU per liter.
Primary Hyperparathyroidism

Primary HyperparathyroidismIn primary hyperparathyroidism, serum calcium levels are elevated in the context of nonsuppressed parathyroid hormone levels. It is most often caused by a single parathyroid adenoma.Patients with mild hyperparathyroidism are at increased risk for renal stones, cortical bone loss, and fractures.Evaluation should include measures of serum calcium, intact parathyroid hormone, 25‐hydroxyvitamin D, glomerular filtration rate, 24‐hour urine calcium excretion, and bone density (including the distal third of the radius), as well as a renal ultrasound examination to detect stones.Surgery is recommended for patients younger than 50 years of age and for patients with clinically significant hypercalcemia, osteoporosis or a fragility fracture, renal calculi, hypercalciuria (especially with a lithogenic urine biochemical profile), or impaired renal function.Medical management includes correction of dietary calcium and vitamin D insufficiency. Cinacalcet lowers serum calcium levels but does not affect rates of bone loss. Bisphosphonates improve bone density, but whether they reduce the risk of fracture is unknown.Surgery does not correct cardiovascular abnormalities in hyperparathyroidism, and whether it alleviates psychiatric and cognitive deficits is a subject of controversy.
A survey of wearers of low water content hydrogel contact lenses

Poly‐2‐hydroxyethylmethacrylate (HEMA) remains the most widely used of all contact lens materials. To explore the application of HEMA in current contact lens practice, we conducted a survey of 104 wearers of HEMA contact lenses presenting consecutively to a large contact lens clinic. Significant differences were found between the in vivo water content of different lens types, indicating that certain differences exist between materials generally classified as ‘HEMA’. Reporting of the symptom of ‘dryness’ was correlated with the measurement of a lower lens water content. The phenomenon of lens aging could not be explained by changes in lens water content.
Paediatric lung function testing : determinants and reference values

Paediatric lung function tests provide objective measures in diagnosis and follow-up of lung diseases, and give insight in the pathophysiology of lung growth and development. In the first part of the thesis, paediatric lung function tests were used to investigate determinants of lung growth and development. The implementation of smoke free legislation resulted in less pregnant women being exposed to environmental tobacco smoke, and a concomitant rise in birth weight and birth-weight-adjusted neonatal lung function. Prenatal tobacco smoke exposure resulted in reduced neonatal lung function in healthy newborns, but this did not persist into childhood when there was no postnatal smoke exposure. Parental smoking during childhood resulted in diminished airway function in healthy children, with the most marked decrease in peripheral airway function. Furthermore, in healthy newborns parental lung function was found to be a determinant of neonatal lung function. Additionally, children with accelerated weight gain during the first 3 months of life had more wheezing complaints in early childhood and decreased lung function at the age of five. The second part of the thesis focussed on the use of paediatric lung function testing and reference values in clinical practice. New reference values for paediatric lung function tests were generated. They provide a more valid estimation of a patient’s lung function and result in less over- and underdiagnosis of pulmonary diseases. Measurement of interrupter resistance was found not to be an alternative for forced expiratory volume measurements to diagnose bronchial hyperresponsiveness in individual patients. An exhalation time of six seconds during exhaled Nitric Oxide measurements showed good agreement with the standard exhalation time of 10 seconds and was favoured by young children
Psychotherapy for Military-Related PTSD: A Review of Randomized Clinical Trials.

IMPORTANCE Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder common among military personnel and veterans. First-line psychotherapies most often recommended for PTSD consist mainly of "trauma-focused" psychotherapies that involve focusing on details of the trauma or associated cognitive and emotional effects. OBJECTIVE To examine the effectiveness of psychotherapies for PTSD in military and veteran populations. EVIDENCE REVIEW PubMed, PsycINFO, and PILOTS were searched for randomized clinical trials (RCTs) of individual and group psychotherapies for PTSD in military personnel and veterans, published from January 1980 to March 1, 2015. We also searched reference lists of articles, selected reviews, and meta-analyses. Of 891 publications initially identified, 36 were included. FINDINGS Two trauma-focused therapies, cognitive processing therapy (CPT) and prolonged exposure, have been the most frequently studied psychotherapies for military-related PTSD. Five RCTs of CPT (that included 481 patients) and 4 RCTs of prolonged exposure (that included 402 patients) met inclusion criteria. Focusing on intent-to-treat outcomes, within-group posttreatment effect sizes for CPT and prolonged exposure were large (Cohen d range, 0.78-1.10). CPT and prolonged exposure also outperformed waitlist and treatment-as-usual control conditions. Forty-nine percent to 70% of participants receiving CPT and prolonged exposure attained clinically meaningful symptom improvement (defined as a 10- to 12-point decrease in interviewer-assessed or self-reported symptoms). However, mean posttreatment scores for CPT and prolonged exposure remained at or above clinical criteria for PTSD, and approximately two-thirds of patients receiving CPT or prolonged exposure retained their PTSD diagnosis after treatment (range, 60%-72%). CPT and prolonged exposure were marginally superior compared with non-trauma-focused psychotherapy comparison conditions. CONCLUSIONS AND RELEVANCE In military and veteran populations, trials of the first-line trauma-focused interventions CPT and prolonged exposure have shown clinically meaningful improvements for many patients with PTSD. However, nonresponse rates have been high, many patients continue to have symptoms, and trauma-focused interventions show marginally superior results compared with active control conditions. There is a need for improvement in existing PTSD treatments and for development and testing of novel evidence-based treatments, both trauma-focused and non-trauma-focused.
Shortage of therapy radiographers: local problem or UK crisis?

Towards the end of 1998 the Radiotherapy Service Managers from Clatterbridge Centre for Oncology, Lancashire & Lakeland Radiotherapy Unit and Christie Hospital in the North West Region began to have serious concerns about the recruitment and retention of therapy radiographers in the region. The concerns related to the difficulty in recruiting to vacant posts. The Society of Radiographers suggested that the problem was patchy and was, more than likely, a local problem. However, the number of advertisements and flyers coming to the three departments suggested otherwise. In order to quantify the perceived problem it was decided to conduct a survey of all 62 radiotherapy departments (including those from the independent sector) and 17 education establishments in England, Scotland, Wales and Northern Ireland.