Miracle-dz/UniFAR-FTUs huggingface dataset:
Decreased survival of subjects with elevated liver function tests during a 28‐year follow‐up

The long‐term survival of subjects with nonalcoholic fatty liver disease (NAFLD) in comparison with both individuals with elevated transaminases attributable to other causes and the general poulation is poorly characterized. This study was undertaken to determine the frequency of NAFLD in a cohort of subjects who underwent liver biopsy from 1980 to 1984 because of elevated liver enzymes, and to assess mortality among subjects with NAFLD in comparison with the general Swedish population. The 256 subjects (61% men) had a mean age of 45 ± 12 years at the inclusion. Liver biopsies were blindly scored for NAFLD and nonalcoholic steatohepatitis (NASH). Causes of death were ascertained from the national Swedish Cause of Death Registry. Fatty liver was detected in 143 of the 256 subjects, including 25 (10%) with alcoholic fatty liver disease and 118 (46%) exhibiting NAFLD. Of those, 51 (20%) were classified as NASH and 67 (26%) as nonalcoholic bland steatosis. Cirrhosis was present in 9% at inclusion. During the follow‐up period, 113 (44%) of the total population and 47 (40%) of the 118 subjects diagnosed with NAFLD died. Of the 113 deaths, 37 were of cardiovascular disease and 16 of liver diseases. Compared with the total Swedish population, adjusted for sex, age, and calendar period, subjects with NAFLD exhibited a 69% increased mortality (standardized mortality ratio [SMR] = 1.69; 95% confidence interval [CI], 1.24–2.25); subjects with bland steatosis, a 55% increase (SMR, 1.55; 95% CI, 0.98–2.32; P = 0.062); and subjects with NASH, 86% (SMR, 1.86; 95% CI, 1.19–2.76; P = 0.007). Conclusion: Patients with NASH are at increased risk of death compared with the general population. Liver disease is the third most common cause of death among patients with NAFLD. (HEPATOLOGY 2009.)
The Multimethod Evaluation of a Nursing Information System in Taiwan

The purpose of this study was to evaluate the impact of a nursing information system on nurses' daily practice. A multimethod evaluation was used that combined both quantitative and qualitative approaches to explore the influence of this technology from different perspectives. The data collection methods included the following: an evaluation scale of the system function, focus group interviews about the users' experiences, and work sampling observation of their work pattern. The data were collected from October to December 2006. The data analysis contained 623 valid questionnaires, 24 nurses' interview content, and 22830 observed nursing activities. Overall, the results indicated that nurses gave a positive evaluation of the technology in their work routine. However, they were concerned about the inadequacy of the hardware devices and response time, training and workflow change, and personal interactions with physicians and patients. Nurses on the night shift spent more time on documentation than on any other nursing activities during the three shifts. The users' technology adoption could be attributed to device sufficiency and function, content design, and workflow efficiency. It is recommended that organizations provide sufficient computer devices, ensure the content design for nursing documentation, and implement expectations for interdisciplinary cooperation.
Improving Adolescent Nutrition: An Uphill Battle

Copyright © 2009 SAGE Publications T he dramatic rise of obesity in childhood and adolescence is staggering. The decline in physical activity, aggressive advertising of poorly nutritious food to youth, and poor eating habits have contributed to this epidemic. The associated rise in diabetes, with more than 170 000 adolescents having this disease and nearly 2 million with prediabetes, clearly defines the scope of this problem. National Health and Nutrition Examination Survey (NHANES) data from 2003-2004 indicate that more than 17% of 12to 19-year-olds are overweight. With such a significant number of our adolescents demonstrating weight difficulties, the predicted rise in cardiovascular disease of this vulnerable population is disheartening. One critical feature of lifestyle medicine is its focus on prevention. Unfortunately, little evidence-based data clearly outline the best ways to prevent and treat overweight and obesity. Using the little data that do exist and a lot of common sense can and should be used by clinicians to prevent and treat the nutritional and weight challenges of our youth. Dr Rampersaud, leading nutritionist and author of this month’s lead article in the journal on the benefits of breakfasts consumption by adolescents, gives the sensible recommendation: “Children should be encouraged to eat an energy-appropriate, nutrient-dense breakfast as part of an overall lifestyle strategy that includes consuming a healthy diet, engaging in regular physical activity, and engaging in activities or lifestyle choices that contribute positively to social and mental health. ” This lifestyle medicine message needs to be heard by patients and their families throughout all the physician and dietitian offices around the world and is a message that clearly outlines the formula for good health. Most of us, let alone our adolescents, do not know what our energy requirements are, what nutrient-dense foods are, what really defines a healthy diet, and how much physical activity is necessary to maintain health and weight. If we did know this message and lived this type of healthy lifestyle, two thirds of Americans would not likely
Effects of MicroRNA‐29 on apoptosis, tumorigenicity, and prognosis of hepatocellular carcinoma

Based on microarray data, we have previously shown a significant down‐regulation of miR‐29 in hepatocellular carcinoma (HCC) tissues. To date, the role of miR‐29 deregulation in hepatocarcinogenesis and the signaling pathways by which miR‐29 exerts its function and modulates the malignant phenotypes of HCC cells remain largely unknown. In this study, we confirmed that reduced expression of miR‐29 was a frequent event in HCC tissues using both Northern blot and real‐time quantitative reverse‐transcription polymerase chain reaction. More interestingly, we found that miR‐29 down‐regulation was significantly associated with worse disease‐free survival of HCC patients. Both gain‐ and loss‐of‐function studies revealed that miR‐29 could sensitize HCC cells to apoptosis that was triggered by either serum starvation and hypoxia or chemotherapeutic drugs, which mimicked the tumor growth environment in vivo and the clinical treatment. Moreover, introduction of miR‐29 dramatically repressed the ability of HCC cells to form tumor in nude mice. Subsequent investigation characterized two antiapoptotic molecules, Bcl‐2 and Mcl‐1, as direct targets of miR‐29. Furthermore, silencing of Bcl‐2 and Mcl‐1 phenocopied the proapoptotic effect of miR‐29, whereas overexpression of these proteins attenuated the effect of miR‐29. In addition, enhanced expression of miR‐29 resulted in the loss of mitochondrial potential and the release of cytochrome c to cytoplasm, suggesting that miR‐29 may promote apoptosis through a mitochondrial pathway that involves Mcl‐1 and Bcl‐2. Conclusion: Our data highlight an important role of miR‐29 in the regulation of apoptosis and in the molecular etiology of HCC, and implicate the potential application of miR‐29 in prognosis prediction and in cancer therapy. (HEPATOLOGY 2010.)
Use of homeopathy in NHS not justified

No evidence exists to justify the use of homoeopathy in the NHS, an in-depth analysis of published data has concluded. The study, carried out by the NHS Centre for Reviews and Dissemination, based at York University, reviewed data from over 200 randomised clinical trials of homoeopathy in a variety of conditions. It concluded that not only was there little evidence to support the efficacy of homoeopathy, but the data that did exist were of poor quality and came from trials that were often deeply flawed. Common problems included under-powered …
Myocardial infarction in a neonate with left‐sided congenital diaphragmatic hernia

We present a case study of a newborn girl with a left‐sided congenital diaphragmatic hernia and a myocardial infarction (MI). The occurrence of MI in newborns has been associated with cardiac malformations and abnormalities of the coronary arteries or thromboembolization. In our patient, echocardiography revealed left ventricular dysfunction, persistent pulmonary hypertension and an inferolateral MI. Within 24 hours cardiac function and oxygenation did not improve and the baby died. Autopsy showed massive MI, a small aortic valve and ascending aorta, and hypoplasia of the distal aortic arch and isthmus. An accessory spleen was also present. The present report underlines the importance of cardiac evaluation in patients with congenital diaphragmatic hernia.
Catheter-Associated Urinary Tract Infection: A Successful Prevention Effort Employing a Multipronged Initiative at an Academic Medical Center

An interdisciplinary clinical improvement workgroup was formed at this academic medical center with the goal of reducing catheter-associated urinary tract infections (CAUTIs). In 2011, the CAUTI rate was noted to be 4.7 CAUTIs per 1000 catheter days. Rounding by 2 lead clinical nurse specialists revealed deficiencies in current practice, which were addressed with multifaceted strategies, including evidence-based indwelling urinary catheter and bladder management protocols, education of staff, reporting of data, and utilization of an icon in the electronic health record (EHR). After the implementation of these strategies, the CAUTI rate decreased and was noted to be 2.4 in February 2013. In addition to this, there was a downward trend line for catheter days.
Reducing Falls and Fall-Related Injuries in Medical-Surgical Units: One-Year Multihospital Falls Collaborative

On the basis of fall injury program characteristics across multiple inpatient medical-surgical units from 6 medical centers, we developed and implemented an operational strategic plan to address fall and injury prevention program attributes and enhance program infrastructure and capacity. Expert faculty provided lectures and served as coaches and mentors through triweekly conference calls and collaborative e-mail exchange. Statistically significant findings support improved fall and injury prevention program components and processes at the organizational and unit levels.
Exploring response shift in longitudinal data

OBJECTIVE: To evaluate recall bias in the thentest and to explore response shifts in chronically ill patients over time. METHODS: In a five-year study of 93 multiple sclerosis patients, kappa statistics examined recall bias in thentest scores. The thentest examined changes in internal standards. Longitudinal factor analysis investigated changes in conceptualization in evaluating quality of life (QOL). RESULTS: Standard analyses revealed deteriorating physical role performance but stability in other QOL indicators over time. Agreement between baseline indicators and thentest scores was lower for fatigue than for ambulation ( p<0.02), suggesting that the thentest captures recalibration response shift (17%) along with recall bias (22%). Patients changed internal standards for physical role limitations ( p<0.05) and fatigue ( p<0.0001), and reconceptualized QOL with respect to well-being and physical role. CONCLUSIONS: Underlying response shifts allowed patients to maintain homeostasis in reported QOL despite physical deterioration. These shifts interrelate but are not redundant. More variance in the thentest was explained by recall bias than by recalibration response shift.
A meta‐analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma

Knowing the spontaneous outcome of hepatocellular carcinoma (HCC) is important for designing randomized controlled trials (RCTs) of new therapeutic approaches; however, survival of patients in the absence of treatment is highly variable, and prognostic factors influencing outcomes are incompletely defined. The aims of this meta‐analysis were to estimate the 1‐year and 2‐year survival rates of untreated HCC patients enrolled in RCTs of palliative treatments, and to identify prognostic factors. RCTs evaluating therapies for HCC with placebo or no‐treatment arms were identified on MEDLINE through April 2009. Data were combined in a random effect model. Primary outcomes were 1‐year and 2‐year survival. Thirty studies met the inclusion criteria. The pooled estimates of the survival rates were 17.5% at 1 year (95% confidence interval [95%CI], 11%‐27%; range, 0%‐75%) and 7.3% at 2 years (95%CI, 3.9%‐13%; range, 0%‐50%). Heterogeneity among studies was highly significant (P < 0.0001) both for 1‐year and 2‐year survival, and persisted when RCTs were stratified according to all patient and study features. Through meta‐regression, impaired performance status, Child‐Pugh B‐C class, and presence of portal vein thrombosis were all independently associated with shorter survival. Ascites was strongly linked to a worse outcome in intermediate/advanced Barcelona Clinic Liver Cancer stages. Conclusion: This meta‐analysis confirms the heterogeneity of behavior of untreated HCC and provides a sound basis for stratifying patients with HCC according to expected survival in future trials of new anti‐cancer agents. (HEPATOLOGY 2010.)
Preventing Mix-Ups between various Formulations of Amphotericin B; Arixtra is Not a Hemostat; Measurement Mix-Up; Drug Names Too Close for Comfort; New Vaccine Errors Reporting Program

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.
Mood Disturbance and Withdrawal Severity in Substitution Treatment for Opioid Dependence: Their Association and Impact on Continued Illicit Drug Use

ObjectivesThis study explored the relationship between withdrawal severity and mood disturbance, and their links with continued illicit drug use during the first 3 months of opioid substitution treatment (ST). MethodsSixteen participants undergoing opioid ST with methadone (n=7) or buprenorphine (n=9) were recruited through outpatient units in South Australia. In a within-groups repeated measures design, the Opiate Treatment Index was administered at baseline and again at 3 months. Participants also completed the Methadone Symptoms Checklist and the Profile of Mood States at baseline and fortnightly throughout the 3-month measurement period. ResultsWithdrawal severity and mood disturbance were observed to co-vary over the 3 months. Statistically significant reductions in both withdrawal severity and mood disturbance were observed. The direction of association between withdrawal severity and mood disturbance was positive and was statistically significant at all measurement points. Continued use of illicit drugs was associated with higher levels of both mood disturbance and withdrawal severity. ConclusionsWithdrawal severity and mood disturbance co-vary over time and have important implications for treatment outcomes in ST.
Exenatide once weekly for the treatment of type 2 diabetes

Exenatide is the first glucagon-like peptide-1 (GLP-1) receptor agonist approved for the treatment of type 2 diabetes mellitus (T2DM). Exenatide lowers blood glucose through multiple mechanisms, including enhancement of glucose-dependent insulin secretion, suppression of excess glucagon secretion, reduction of food intake and slowing of gastric emptying. The current formulation of exenatide requires twice-daily dosing (exenatide BID), and an extended-release formulation of exenatide is now in development for use as a once-weekly injection (exenatide QW). The purpose of this report is to review the most current clinical data on the development of exenatide QW for the treatment of T2DM. In clinical trials, exenatide QW significantly improved glycemic control, resulted in patient weight loss, and was well tolerated in patients with T2DM. In a head-to-head clinical trial, exenatide QW caused greater improvements in glycemic control and was better tolerated than exenatide BID. Given the rapidly increasing prevalence of diabetes and obesity worldwide, exenatide QW is a promising development candidate for the treatment of T2DM.
Dissociation between liver inflammation and hepatocellular damage induced by carbon tetrachloride in myeloid cell–specific signal transducer and activator of transcription 3 gene knockout mice

Liver injury is associated with inflammation, which is generally believed to accelerate the progression of liver diseases; however, clinical data show that inflammation does not always correlate with hepatocelluar damage in some patients. Investigating the cellular mechanisms underlying these events using an experimental animal model, we show that inflammation may attenuate liver necrosis induced by carbon tetrachloride (CCl4) in myeloid‐specific signal transducer and activator of transcription 3 (STAT3) knockout mice. As an important anti‐inflammatory signal, conditional deletion of STAT3 in myeloid cells results in markedly enhanced liver inflammation after CCl4 injection. However, these effects are also accompanied by reduced liver necrosis, correlating with elevated serum interleukin‐6 (IL‐6) and hepatic STAT3 activation. An additional deletion of STAT3 in hepatocytes in myeloid‐specific STAT3 knockout mice restored hepatic necrosis but decreased liver inflammation. Conclusion: Inflammation‐mediated STAT3 activation attenuates hepatocellular injury induced by CCl4 in myeloid‐specific STAT3 knockout mice, suggesting that inflammation associated with a predominance of hepatoprotective cytokines that activate hepatic STAT3 may reduce rather than accelerate hepatocellular damage in patients with chronic liver diseases. Hepatology 2010
Exploring Gender Differences in the Association Between Young African American Mothers' Reports of Preschoolers' Violence Exposure and Problem Behavior

The prevalence of children's violence exposure, particularly among ethnic minorities living in urban areas, is troubling. Gender differences in the rates and effects of violence exposure on behavior have been found for older children, and the current study extends this research to preschool-age children. We draw on data collected from a sample of 3- to 5-year-olds born to 230 adolescent African American mothers living in Washington, DC. Girls and boys were exposed to comparable levels of witnessed and directly experienced violence. In contrast to findings from studies of older children, preschool-age boys' and girls' externalizing and internalizing behavior were comparably associated with directly experienced and witnessed violence. These findings highlight the importance of further developmental research to differentiate the effects of violence exposure as children grow older.
The Doctor Business.

We all have watched the floods of anger and annoyance raising the water in the great reservoir of ill will against physicians, against "organized medicine," and against the American Medical Association. The dams of restraint have burst, and this book has come flooding out full of passion and outrage. Though the author is no beatnik throwing in the towel of life, he has carried his privilege of weeping at the wailing wall beyond the call of duty. He floats off in an ocean of tears, as Alice in Wonderland did, beset by hordes of imaginary rodents. Most of the criticisms about the medical profession are true in the case of some doctors. The good physician deplores this as bitterly as Carter does. But medicine has no monopoly on evil. In spite of what one would judge from Carter's book, physicians are much oftener than not compassionate and hard working and
Reduction of β‐amyloid peptide42 in the cerebrospinal fluid of patients with Alzheimer's disease

In this clinical study, the cerebrospinal fluid (CSF) level of a Novemberel form of the β‐amyloid peptide (Aβ) extending to position 42 (Aβ42) was determined in patients with Alzheimer's disease (AD) as well as controls. In addition to measurement of CSF Aβ42 levels, total Aβ peptides, microtubule‐associated protein τ, and apolipoprotein E (ApoE) genotype were also assessed. It is interesting that CSF Aβ42 levels were found to be significantly lower in AD patients relative to controls, whereas total Aβ levels were not. Aβ42 has recently been shown to preferentially deposit in the brain tissue of patients with AD, suggesting that diminished clearance may account for its reduction in CSF. As previously reported, τ levels were increased in AD patients; however, neither Aβ42 nor τ levels were apparently influenced by the ApoE genotype.
Relationships Between Processes and Outcomes of Nurse Practitioners in Acute Care: An Exploration

This nonexperimental repeated-measure study examined the relationships between processes (coordination of care, and provision of counseling and education) and outcomes (symptom resolution, functional status, and satisfaction with care) expected of acute care nurse practitioners (ACNPs). The data were obtained from 320 patients admitted to medical, surgical, and cardiac units. The results indicated positive association between the process and outcome variables, providing initial evidence delineating care processes of ACNPs that contribute to the achievement of nursing-sensitive outcomes.
Interparental Conflict in Context: Exploring Relations Between Parenting Processes and Children's Conflict Appraisals

Children's appraisals of conflict are a mechanism by which parental discord can lead to child maladjustment. The cognitive-contextual framework proposes that parent–child relationships may affect how children perceive conflict, but this idea has rarely been examined empirically. This study investigated relations between conflict appraisals, parenting, and child adjustment in a sample of 150 8- to 12-year-old children, using a multi-informant, multimethod design. Mothers' coercive/controlling and emotionally unsupportive parenting magnified the relation between conflict and children's self-blame; emotionally supportive parenting diminished this association. Children's secure attachment with fathers was linked with less threat and self-blame; more security reduced self-blame for conflict. Data suggest that supportive, responsive parenting can buffer the effects of interparental conflict on children by reducing self-blaming attributions for parental discord.