Miracle-dz/UniFAR-FTUs huggingface dataset:
Improving patient diary use in intensive care: A quality improvement report

Background Patients surviving critical illness are at risk of developing psychological symptoms that affect quality of life and recovery. Patient diaries may improve psychological outcomes by reducing gaps in memory and contextualising what has happened during admission. Factors including lack of guidelines, lack of awareness and time constraints may lead to poor diary use. Aims This quality improvement project aimed to increase diary provision and overall multidisciplinary team engagement with diaries for all patients admitted for over 72 h to an intensive care unit. Methods Trialled changes implemented via the ‘Plan-Do-Study-Act’ method included adding alerts to the online patient note system, providing education sessions and introducing a guidance document to facilitate entry completion. Results A ‘diary provision’ target of 100% was achieved (from a baseline of 26.1%). Simple changes have proven effective in establishing routine engagement with diaries, and lessons may be used to improve diary systems elsewhere.
Comparison of the groups treated with mirtazapine and selective serotonine reuptake inhibitors with respect to birth outcomes and severity of psychiatric disorder

ABSTRACT Objective: The literature provides very limited information on mirtazapine usage in the pregnancy period. The groups including pregnant women who used SSRI or mirtazapine as a single treatment, SSRI–mirtazapine combination treatment and unmedicated groups were compared with respect to illness severity and birth outcomes. Method: The study sample included 120 pregnant women; 40 women with SSRI usage, 16 women with mirtazapine usage, 18 women with combined SSRI- mirtazapine usage, 23 women with unmedicated psychiatric disorder and who elected not to take medication during their pregnancy or discontinued antidepressants by themselves, and 23 healthy control women. Results: No difference was obtained with regard to the gestation week of birth, birth weight, the duration of stay in the neonatal care unit among the SSRI, mirtazapine, SSRI–mirtazapine combination, unmedicated patient and control groups. The likelihood of a new diagnosis was highest in the mirtazapine group. The majority of pregnant women whose psychiatric disorders were more severe and more relapsed used SSRI–mirtazapine combination treatment. Conclusion: No difference was observed between the SSRI and mirtazapine usage in the pregnancy period with regard to the birth outcomes. Similar birth outcomes could present clinicians with the option of prescribing mirtazapine as a safe alternative to SSRI in the treatment of antenatal psychiatric patients.
ASSESSMENT OF THE APPROPRIATE UTILIZATION OF IMIPENEM/CILASTATIN IN A TERTIARY CARE HOSPITAL

Background: Imipenem/cilastatin is a broad spectrum antibiotic possessing activity against clinically important aerobic gram positive, gram negative species, and anaerobes. Misuse of this medication has been associated with preventable adverse events, increase in healthcare cost and the emergence of resistant organisms. Objective: The objective of this study was to evaluate the utilization of imipenem/cilastatin in a tertiary care hospital regarding its indication, dosage, response, and duration of use. Methods: Charts of all patients receiving imipenem/cilastatin at Rafik Hariri University Hospital (RHUH) during the months of August and September 2008 were reviewed. Results: One hundred and sixteen patients were included in the analysis. Most studied patients were on the internal medicine floor (44%)(n=55), followed by intensive care unit (ICU) (19%)(n=22) and the oncology floor (15.5%)(n=18). The most common types of infections were urinary tract infections (26.7%)(n=31), respiratory tract infections (17.2%)(n=20), sepsis (14.7%)(n=17), and febrile neutropenia (8.6%)(n=10). The indication of imipenem/cilastatin was appropriate in 96.6% of patients (n=112), questionable in 2.6% (n=3), and inappropriate in 0.9% (n=1). The dose was appropriate in 75.9% of patients (n=88), could not be assessed in 23.3 % (n=27), and inappropriate in 0.9% (n=1). The duration of therapy was appropriate in all patients (100%)(n=116). Therapy was successful in 91 patients (78.4%), could not be assessed in 22 patients (19%), and 3 patients (2.6%) failed to respond to therapy. The most common missing criteria were height and weight in 27 patients. Two patients had seizure episodes while on the medication after which the drug was discontinued. Conclusion: The use of imipenem/cilastatin was appropriate in the majority of patients. Healthcare professionals should be educated on the importance of obtaining patients' height and weight, since they are required for dose calculation.
Code blue practice in patient safety: Single center retrospective evaluation

Aim: Code Blue intervention is management system that ensure the most rapid and effective resuscitation of a patient in respiratory or cardiac arrest. The aim of the study was to evaluate the current code blue intervention in our hospital and to identify the practical problems associated with functioning of the code blue. Material and Methods: The study population included all patients who code blue had been activated. Data were collected using code blue forms. It was evaluated the age, gender, time to reach the patient, CPR time, the initial rhythm and the results of the application. Results: 188 patients who were given code blue in our hospital in one year were included in the study. The mean age of the patients was 73.4±14.45 years. 55% of the patients were male and 45% were female. The time for the code blue team to arrive was 3.32±1.97 minutes. Cardiopulmonary arrest was not present in 21.80 % of the blue-coded patients, and resuscitation was not required. Percent 78.20 patients were cardiac arrest and resuscitation was performed. The mean administration time of CPR was performed at 28.16±13.36 minutes. The initial rhythms were ventricular tachycardia / ventricular fibrillation (49%), followed by bradycardia (28%) and pulseless electrical activity / asystole (23%). Percent 21.08 patients returned to circulation and 78.19 % patients did not respond. The most common place for code blue was the palliative care unit. Conclusion: The overall survival rate was 21.08 % in the hospital. The code blue application requires repeated education and a periodic assessment of site-specific problems. We concluded that the application of code blue carried out by a trained team is an essential standard in hospitals.
Energy balancing using charge/discharge storages control and load forecasts in a renewable-energy-based grids

Renewable-energy-based grids development needs new methods to maintain the balance between the load and generation using the efficient energy storages models. Most of the available energy storages models do not take into account such important features as the nonlinear dependence of efficiency on lifetime and changes in capacity over time horizon, the distribution of load between several independent storages. In order to solve these problems the Volterra integral dynamical models are employed. Such models allow to determine the alternating power function for given/forecasted load and generation datasets. In order to efficiently solve this problem, the load forecasting models were proposed using deep learning and support vector regression models. Forecasting models use various features including average daily temperature, load values with time shift and moving averages. Effectiveness of the proposed energy balancing method using the state-of-the-art forecasting models is demonstrated on the real datasets of Germany’s electric grid.
Recognition of central nervous system sensitization and its risk factors in patients with unilateral musculoskeletal shoulder pain

BACKGROUND: Overall, inferences from the majority of the literatures reviewed provide increasing evidence on the presence of central nervous system sensitization in unilateral shoulder pain. The possibility of presence of central sensitization (CS) among patients with unilateral musculoskeletal shoulder pain has not been adequately explored till date. The term “unilateral shoulder pain” in this study will be used to refer to nonneuropathic shoulder pain of different etiologies including rotator cuff pathology, adhesive capsulitis, or labral lesion. OBJECTIVES: The purpose of this study was to determine the presence of a subgroup of patients among patients with unilateral musculoskeletal shoulder pain and to further explore what extent the central nervous system sensitization correlates with other clinical measures. METHODS: Ninety-one patients with unilateral musculoskeletal shoulder pain participated in this cross-sectional study. Standardized outcome measures such as Central Sensitization Inventory-Gujarati (CSI-G) for the presence of CS, pressure pain threshold by pressure algometry, and Shoulder Pain and Disability Index for disability were administered as per standardized protocol. RESULTS: The results of the present study showed that 17 (18.7%) patients had CS. The CSI score had mild correlation with the demographic and clinical outcome measures and comorbidities such as gender (r = 0.208), duration of the condition (r = 0.208), hypertension (r = −0.238), sleep disturbance (r = −0.327), numbness (r = −0.238), and fatigue perception (r = −0.314) by the pain and disability score also had mild correlation with CSI score (P, 0.05). The risk ratio for sensitization was 2.40 for female gender, 3.07 for hypertension, 3.19 for sleep disturbance, 2.06 for numbness, and 3.87 for perceived fatigue in patients with unilateral musculoskeletal shoulder pain. CONCLUSION: The present study showed that the central nervous system becomes hypersensitive in a subgroup of patients and weakly related to factors such as female gender, chronicity of shoulder pain, hypertension, pain and disability, sleep disturbance, and perceived fatigue in patients with unilateral musculoskeletal shoulder pain.
MC044h, a phase II trial of sorafenib in patients (pts) with metastatic neuroendocrine tumors (NET): A Phase II Consortium (P2C) study

4504 Background: Treatment options for metastatic NET, including islet cell carcinoma (ICC) and carcinoid tumor (CT), are limited. These tumors frequently express vascular endothelial growth factor receptor-2 (VEGFR-2) and platelet derived growth factor receptor receptor-β (PDGFR-β). Sorafenib, a small-molecule inhibitor of the VEGFR-2 and PDGFR-β tyrosine kinase domains, is a rational targeted therapy to evaluate in NET. Methods: Eligibility criteria included: ECOG PS = 2, = 1 prior chemotherapy, good organ function and signed informed consent. Prior interferon and prior or concurrent octreotide at a stable dose were allowed. Pts unable to take oral medications, with uncontrolled hypertension or with symptomatic coronary artery disease were excluded. Pts received sorafenib 400 mg po BID. Primary endpoint was response by RECIST in two cohorts (ie, CT and ICC) using separate 2-stage phase II designs. Results: 93 pts were enrolled: (50 CT, 43 ICC). For pts evaluable for the primary endpoint, 4 of 41 (10%) C.
Cephalometric Evaluation of Bionator Therapy in the Early Treatment of Class II Malocclusions

Early or two-phase orthodontic treatment of Class II malocclusions is a debated topic in orthodontic circles primarily because the benefits of early intervention have not been consistently reproduced among researchers. The present study was a retrospective analysis of cephalograms from patients with Class II, division 1 malocclusions at the start of treatment. These were 50 consecutively treated youths who received phase 1 (early) treatment with a Bionator appliance and later treatment with full appliances (all treated by a single clinician). The comparison group consisted subjects treated in a single phase with fixed Edgewise appliances only. Importantly, subjects in the two samples were matched, on a one-to-one basis, for demographic and cephalometric variables (ANB, SNA, SNB, NAP, FMA) to ensure comparability in the nature and severity of the malocclusions. The key question was whether the cephalometric results at the end of treatment were comparable between groups. Two-phase subjects were treated on average 1.4 years longer than the one-phase group, though this measure of clock time may obscure the greater ease of treatment chair side. Neither of out two integumental variables (Z angle, E plane) differed statistically, but two key skeletal variables did differ, namely ANB and NAP. ANB was significantly smaller ( x = 2.6°) in the twophase group than in the one-phase group ( x = 3.7°), and NAP averaged 2.7o in
Spontaneous Intracranial Vertebral Artery Dissection in a 2-Year-Old Child Diagnosed with High-Resolution MRI: a Case Report

Vertebral artery dissection (VAD) is a rare cause of posterior circulation stroke in children. VAD in children was first reported in 1970 by Ouvrier and Hopkins and the number of cases has risen ever since, though the incidence of VAD in this age group is still unreported (1, 2). The predisposing factors for VAD often include trauma, cervical anomaly, or systemic connective tissue diseases such as fibromuscular dysplasia. Spontaneous VAD in children is also, and it accounts for about 26% of the cause (1). VAD presents diverse symptoms including visual disturbances, hemiparesis, ataxia, headache, nausea and vomiting. Non-specific symptoms make early diagnosis difficult, causing an inappropriate delay in treatment. Conventionally, catheter angiography is considered the gold standard in the diagnosis of vertebral artery dissection. Severe stenotic changes with slow flow, vessel wall irregularity, and the presence of an intimal flap are known as the angiographic findings of VAD, intimal flap being the most definitive sign (3). But catheter angiography does not always ensure definite diagnosis of dissection, due to its inability to evaluate the arterial wall (4). Furthermore, its invasiveness and the inevitable exposure to radiation This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received: March 30, 2019 Revised: May 24, 2019 Accepted: July 29, 2019
Cultural and Organizational Adaptation of the QUOTE Breast Cancer Questionnaire for Italian Breast Units

Background: Quality of care in breast cancer is a widely researched topic, with many objectively measurable indicators of quality in healthcare. However, while there is a large consensus on the importance of patient’s perspective in breast cancer care process, there are only a few tools to measure such subjective indicators, and none of them has been validated for its use in Italy yet. Objectives: The aim of this methodological study was to validate a cultural and organizational adaptation of the quality of care through the patient’s eyes breast cancer (QUOTE-BC) questionnaire for its use in Italian breast units. Methods: The QUOTE-BC questionnaire was translated, adapted for the Italian context and pre-tested on a small sample of breast cancer patients during their hospital stay. The questionnaire was then administered to a large sample of patients from December 2016 to May 2017 in order to further validate it. A visual analogue scale (VAS) was also handed out to assess patients' level of satisfaction. Results: A total of 212 patients filled the questionnaire. Confirmatory factor analysis corroborated the five-factor structure of the original questionnaire explaining 80.2% of the total variance. The Cronbach alpha ranged from 0.69 to 0.84 showed a good level of internal consistency. The VAS difference between the groups of patients giving positive and negative answers showed that, in almost all the items, there was a statistically significant difference in patients’ level of satisfaction between the two groups. Conclusions: In this study, we validated the first Italian adaptation of the QUOTE-BC (IT-QUOTE-BC) questionnaire, which represents a valuable tool for supporting clinical and organizational decisions in Italian breast units. Moreover, the routine use of the IT-QUOTE-BC questionnaire in the same breast unit is a tool to verify the improvement in organizational quality change as perceived by the patients.
EFFECT OF ANKLE BRACING ON RECURRENCE OF ANKLE SPRAIN IN MALE FOOTBALL PLAYERS

Abstract Background and purpose of study: Ankle injuries are among the most common sports-related injuries, accounting for up to 20% of injuries. Ankle sprains account for 33–73% of ankle injuries. The aim of this study was to evaluate the effectiveness of ankle bracing in preventing recurrences of ankle sprains, especially in male soccer players. Methods: A randomized controlled study was conducted in Prince Sattam bin Abdul Aziz University. 30 football players in university football team aged 18 to 23 years were obtained between November 2014 and May 2015, 15 were randomly selected to the study group (Ankle bracing group) and 15 to the control group (Untreated group without bracing). Subjects: All football players who had suffered from past history of ankle sprain (30 players) were identified as subjects. Measurements: Each previously injured ankle (n = 30) was considered as a case for the analysis. Ankles that had a past sprain received one of two groups; ankle bracing group (n = 15) and untreated group (n = 15). Results: There was significant difference between intervention group and control group. Ankle sprain recurrence frequency was 0% and 27% for the braced and control group, respectively. The recurrence incidence for the braced group was significantly fewer than that of the control group. Conclusions: It was concluded that this study suggest that ankle bracing is effective in preventing the incidence of ankle sprains in male football players with a past history of ankle sprains.
Pulmonary Thromboembolism during Femur Surgery under General Anesthesia -A case report-

Although perioperative pulmonary thromboembolisms (PTEs) are not rare, most anesthetists are unfamilar with the condition. We experience a case, which showed a sudden capnographic score drop, increased pumonary arterial pressure, and a D-shaped right ventricle by echocardiography in a femur surgery patient under general anesthesia. The case described provides an example of PTE and should remind anesthetists of the clinical course and treatment of this condition.
Epidemiological, Clinical and Therapeutic Characteristics of Patients with pelvis fractures in Butembo, Democratic Republic of the Congo (DRC)

Introduction: The pelvis fractures are frequent fractures in relation to generally violent traumas seen their frequencies. Thus, we undertook this work with the objective of determining the epidemiological, clinical and therapeutic profile of the pelvis fractures in Butembo town. Material and Methods: This was a retrospective descriptive study based on a literature review during 5 years. Results: During our study, we found a frequency of 5.29% of cases of pelvis fractures or 37 cases in a population of 699 patients with fractures. The male sex was the most affected with a proportion of 59.5%. Pelvis fractures are most common in young adults aged 21-40 (45.9%). Drivers, farmers and students were the most affected with a frequency of 21.6%. Road traffic accidents were the leading cause of pelvis fractures in 67.6% of cases followed by work’s accidents with 10.8%. Fractures of pubis are the most common with a frequency of 32.4%. Pelvis fractures were more associated with bone fractures of limbs, with a frequency of 48.7% followed by cranio encephalic trauma (CET) in 21.6%. Orthopedic treatment is most indicated in 62.9%. 1/3 of the patients had unstable hemodynamic. 83.8% of patients with pelvis fractures were discharged from hospital with an improved condition. Conclusion: Pelvis fractures remain a public health problem; the frequency of these fractures is increasing in Butembo town given the high number of road accidents; and the mortality associated with them is not negligible.
Infection of the surgical sites: a one-year study

I Especialista de II Grado en Cirugía Pediátrica. Profesora Auxiliar. Hospital Pediátrico Universitario de Centro Habana. La Habana, Cuba. II Especialista de I Grado en Pediatría. Máster en Infectología y Enfermedades Tropicales. Asistente. Hospital Pediátrico Universitario de Centro Habana. La Habana, Cuba. III Especialista de I Grado en Cirugía Pediátrica. Hospital Pediátrico Universitario de Centro Habana. La Habana, Cuba. IV Médico General. Hospital Pediátrico Universitario de Centro Habana. La Habana, Cuba.
Spatial cluster analysis of female breast cancer diagnosis in Missouri: using GIS and spatial analyst functions

XIII CHAPTER ONE BACKGROUND AND INTRODUCTION . 1 Study Region . 3 The Burden of Cancer in Missouri over the Years . 5 Purpose of the Study . 11 Significance of the Study . 12 Anticipated Contribution and Potential Uses of Study Findings . 12 Definition of Terms . 13 Tumor Size and Stage at Diagnosis . 13 Types of Staging – Theoretical . 13 Clinical Staging . 13 Pathologic Staging . 14 Staging Systems . 14 The TNM System . 14 Stage Grouping . 16 Rural Health Clinic . 17 Critical Access Hospital . 17 Federally Qualified Health Center . 18 Operational Staging . 18 Potential Access Accessibility – Theoretical . 19 Accessibility Operational . 19 Theoretical Framework . 19
Central Diabetes Insipidus in Patients Without Apparent Initial MR Imaging Findings: A 2-year Follow-up MR Imaging Study

The aim of this study is to describe the follow-up magnetic resonance imaging (MRI) findings in patients with central diabetes insipidus (CDI) patients and without having apparent initial imaging abnormality. This was a retrospective study. In the past 8 years (from 1995 to 2002), 26 patients (male 14, female 12, mean age 20.1 years) were diagnosed as CDI by water deprivation test, 1-desamino-8-D-arginine vasopressin (DDAVP) test, and the relationship between urine-plasma osmolarity. The major clinical manifestations are polyuria and polydipisia. We retrospectively analyzed the MR images. The subtle MR images included (1) loss of high signal intensity (SI) in posterior lobe on T1WI (26.9%, n=7), (2) an empty sella, (11.5%, n=3), (3) shallowing of the pituitary fossa (3.8%, n=1), (4) ectopic bright high signal intensity on T1WI at the hypothalamus (3.8%, n=1), (5) normal (23%, n=6), (6) thickened pituitary stalk thickness (PST) (26.9%, n=7). All these patients were followed at least 2 years with MR images. Seven patients were initially presented as increased pituitary stalk thickness (PST). In the following images, 5 of the seven patients had progressive thickened stalk and underwent the biopsy procedure. They were diagnosed as germinoma, histiocytosis, and sarcoidosis. Two cases of the PST group had static imaging findings in the follow-up images just as in other groups. In our limited experiences the causes of CDI were variable. It is most important to follow up the subtle MR findings. In group with progressive pituitary stalk thickness, we emphasize the necessities to make biopsy for definite diagnosis.