Miracle-dz/UniFAR-FTUs huggingface dataset:
Prevention of Venous Thromboembolism* American College of Chest Physicians Evidence- Based Clinical Practice Guidelines (8th Edition)

This article discusses the prevention of venous thromboembolism (VTE) and is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do or do not outweigh risks, burden, and costs. Grade 2 suggestions imply that individual patient values may lead to different choices (for a full discussion of the grading, see the "Grades of Recommendation" chapter by Guyatt et al). Among the key recommendations in this chapter are the following: we recommend that every hospital develop a formal strategy that addresses the prevention of VTE (Grade 1A). We recommend against the use of aspirin alone as thromboprophylaxis for any patient group (Grade 1A), and we recommend that mechanical methods of thromboprophylaxis be used primarily for patients at high bleeding risk (Grade 1A) or possibly as an adjunct to anticoagulant thromboprophylaxis (Grade 2A). For patients undergoing major general surgery, we recommend thromboprophylaxis with a low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH), or fondaparinux (each Grade 1A). We recommend routine thromboprophylaxis for all patients undergoing major gynecologic surgery or major, open urologic procedures (Grade 1A for both groups), with LMWH, LDUH, fondaparinux, or intermittent pneumatic compression (IPC). For patients undergoing elective hip or knee arthroplasty, we recommend one of the following three anticoagulant agents: LMWH, fondaparinux, or a vitamin K antagonist (VKA); international normalized ratio (INR) target, 2.5; range, 2.0 to 3.0 (each Grade 1A). For patients undergoing hip fracture surgery (HFS), we recommend the routine use of fondaparinux (Grade 1A), LMWH (Grade 1B), a VKA (target INR, 2.5; range, 2.0 to 3.0) [Grade 1B], or LDUH (Grade 1B). We recommend that patients undergoing hip or knee arthroplasty or HFS receive thromboprophylaxis for a minimum of 10 days (Grade 1A); for hip arthroplasty and HFS, we recommend continuing thromboprophylaxis > 10 days and up to 35 days (Grade 1A). We recommend that all major trauma and all spinal cord injury (SCI) patients receive thromboprophylaxis (Grade 1A). In patients admitted to hospital with an acute medical illness, we recommend thromboprophylaxis with LMWH, LDUH, or fondaparinux (each Grade 1A). We recommend that, on admission to the ICU, all patients be assessed for their risk of VTE, and that most receive thromboprophylaxis (Grade 1A).
Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates.

RATIONALE Pneumocystis jiroveci polymerase chain reaction (PCR) has higher sensitivity than conventional stains but cannot distinguish colonization from infection. METHODS We compared P jiroveci PCR and conventional stains in HIV-uninfected immunocompromised patients. RESULTS Among the 448 patients, 296 (66%) patients had hematologic malignancies; 72 (16.1%), bone marrow transplants; 44 (9.8%), solid tumors; 21 (4.7%), renal transplants; and 15 (3.4%) were taking immunosuppressants for systemic diseases. Diagnostic strategy consisted of BAL in 351 patients and induced sputum (IS) in 97 patients. Conventional pneumocystic pneumonia (PCP) stain was positive in 39 (8.7%) patients, including 34 with positive PCR. In addition, PCR was positive in 32 patients, including 21 with complete follow-up, of whom 14 were diagnosed with probable or definitive PCP (a 36% increase). PCR was 87.2% sensitive and 92.2% specific; positive and negative predictive values were 51.5% and 98.7%, respectively. Sensitivity and negative predictive value were 100% on IS. CONCLUSIONS In HIV-uninfected immunocompromised patients with acute pulmonary infiltrates, P jiroveci PCR correlates with clinical evidence of PCP. A negative PCR allows withdrawing anti-PCP therapy.
Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated PET/CT in mediastinal staging of potentially operable non-small cell lung cancer.

BACKGROUND The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) following integrated PET/CT scanning in mediastinal staging of non-small cell lung cancer (NSCLC) has not been assessed. METHODS We prospectively evaluated the diagnostic values of PET/CT scanning and EBUS-TBNA for mediastinal staging in 117 patients with potentially operable NSCLC with accessible mediastinal lymph nodes (diameter range, 5 to 20 mm) by EBUS-TBNA. Subgroup analysis according to histologic type was performed. RESULTS Of 30 cases of mediastinal metastasis, 27 were confirmed by EBUS-TBNA and 3 were confirmed by surgery. EBUS-TBNA results confirmed all cases with true-positive PET/CT scan findings and six of nine cases with false-negative PET/CT scan findings. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of EBUS-TBNA in the detection of mediastinal metastasis were 90.0%, 100%, 100%, 96.7%, and 97.4%, respectively. For PET/CT scans, the values were 70.0%, 59.8%, 37.5%, 85.2%, and 62.4%, respectively (p = 0.052; p < 0.001; p < 0.001; p = 0.011; p < 0.001, respectively). In adenocarcinoma (n = 55), EBUS-TBNA detected four of six cases with false-negative PET/CT scan findings, and the NPV was higher for EBUS-TBNA than for PET/CT scans (94.6% vs 77.8%, respectively; p = 0.044). In squamous cell carcinoma (n = 53), the NPV of EBUS-TBNA and PET/CT scans were similarly high (97.9% vs 96.3%, respectively; p = 0.689). CONCLUSIONS EBUS-TBNA was an effective invasive method following PET/CT scanning in the mediastinal staging of potentially operable NSCLC. In mediastinal PET/CT scan-positive cases, EBUS-TBNA was an excellent tool for detecting mediastinal metastasis. Even in mediastinal PET/CT scan-negative cases, EBUS-TBNA can be useful for confirming mediastinal metastases, especially in adenocarcinoma.
Risk Factors for Fracture in Diabetes: The Canadian Multicentre Osteoporosis Study

Objective. Individuals with diabetes have been found to be at increased risk of nontraumatic fracture. However, within the diabetic population, how to distinguish who is at the highest risk and warranting therapy has remained elusive. Design. Cross-sectional analysis of a national population-based cohort study. Patients. Men and women over the age of 50 with diabetes from across Canada. Measurements. Logistic regression analysis to identify diabetes specific factors associated with a history of one or more non-traumatic fractures. Results. Six hundred and six individuals with diabetes with a mean age of 69 years were examined. Thirty percent had a history of non-traumatic fracture. Macrovascular diseases in the form of stroke or TIA, as well as hypertension, were found to be independently associated with fragility fracture. Other, more traditional, clinical risk factors were also associated with fracture, including increased age, female gender, rheumatoid arthritis, family history of osteoporosis, and decreased bone mineral density. Conclusions. In this cohort of Canadians with diabetes, those with rheumatoid arthritis, a family history of osteoporosis, female gender, increased age, decreased BMD, cerebrovascular disease, or hypertension were more likely to have had a non-traumatic fracture. These risk factors may be important to clinicians when identifying which of their diabetic patients are at highest risk of fracture and in need of preventative therapies.
Treatment of persistent pulmonary air leaks using endobronchial valves.

BACKGROUND Prolonged pulmonary air leaks are a significant source of frustration for patients and physicians. When conventional therapy fails, an alternative to prolonged chest tube drainage or surgery is needed. Bronchoscopic blockage of a bronchus can be performed with the hope of accelerating closure of the air leak by reducing the flow of air through the leak. To our knowledge, this article presents the largest series of patients with prolonged air leaks treated with an endobronchial valve. METHODS With Internal Review Board approval, endobronchial valves were compassionately placed using flexible bronchoscopy in patients with prolonged air leaks at 17 international sites. RESULTS Between December 2002 and January 2007, 40 patients (15 women; mean age +/- SD, 60 +/- 14 years) were treated with one to nine endobronchial valves per patient. The air leaks had recurrent spontaneous pneumothorax (n = 21), postoperative (n = 7), iatrogenic (n = 6), first-time spontaneous pneumothorax (n = 4), bronchoscopic lung volume reduction (n = 1), and trauma (n = 1) etiologies. Nineteen patients (47.5%) had a complete resolution of the air leak, 18 (45%) had a reduction, 2 had no change, and 1 had no reported outcome. The mean time from valve insertion to chest tube removal was 21 days (median, 7.5 days; interquartile range [IQR], 3 to 29 days) and from valve procedure to hospital discharge was 19 +/- 28 days (median, 11 days; IQR, 4 to 27 days). CONCLUSIONS Use of endobronchial valves is an effective, nonsurgical, minimally invasive intervention for patients with prolonged pulmonary air leaks.
The Dietary, Physical Activity and Sedentary Behaviours of Victorian Regional Secondary School Students

The aim of this study was to investigate the dietary, physical activity and sedentary behaviours of adolescents from four secondary schools in Warrnambool, regional Victoria. In 2004, a random sample of students (n=712), stratified by school year level, was generated from school enrolment databases and 443 students completed a lifestyle questionnaire. Twenty per cent of students were physically active for 60 minutes or more per day; 28 per cent used electronic media in free time for a maximum of two hours per day. Only seven per cent of students met these two Australian physical activity recommendations. Fruit, vegetables and dairy products were consumed every day by 39 per cent, 40 per cent and 71 per cent of students respectively; three serves per day of each of these foods are recommended for Australian adolescents. Compared with boys, girls were less physically active (p<0.001), consumed more fruit (p=0.011) and vegetables (p<0.001), but fewer dairy products (p<0.024). Seventeen per cent of students were overweight or obese; these students were less physically active than normal weight peers (p<0.018). The dietary, physical and sedentary behaviours of regional Victorian secondary school students in this study were inadequate when compared with Australian recommendations. Dietary and physical activity habits are still evolving in adolescence and unhealthy habits can still be changed.
An Eclectic Group Program for Nursing Home Residents with Dementia

This paper describes the rationale used in the design of a group treatment program for eldcrly residents with a diagnosis of dementia or organic brain syndrome who lived in a rcsidential center offering multiple levels of care from independent living to skillcd nursing care. The selection pro- cess and general approach are discussed. The assessment procedure is outlined and the meetin format described. Gen- cral results of the project arc provifed. Possible avcnues for further investigation are identified. Disoriented, sensory impaired residents appeared to pre- sent insoluble programming challenges to the social service staff at Jewish Home for the Aged, San Francisco. Cogni- tively impaired individuals, who also demonstrated significant hearing and/or vision losses, appeared unable to benefit from group programs offered within the Activity Program. The
Comparison of the Effects of General and Regional Anesthesia for Cesarean Section on Neonatal Neurologic and Adaptive Capacity Scores

Fifty-two neonates delivered by elective cesarean section were evaluated using the Neonatal Neurologic and Adaptive Capacity Scores. Twenty of the mothers received general anesthesia, 14 received epidural, and 18 received spinal anesthesia. All mothers receiving regional anesthesia were prehydrated with 1000 ml of lactated Ringer's solution and were given oxygen via a transparent face mask. All mothers undergoing general anesthesia received thiopental for induction flouted by N2O-O2 (4 L:4 L) and 0.5% enfliirane until delivery of the baby. All mothers were healthy, not in labor, and were scheduled for elective cesarean section. All neonates weighed 2500 g or more, had Apgar scores of 7 or more at 1 and 5 min, and had normal acid base and blood gas data. Neonates delivered with general anesthesia scored significantly lower on some of the test items for adaptive capacity, passive tone, active tone, primary reflexes, and total scores at both 15 min and 2 hr of age (P < 0.05) than those delivered with either epidural or spinal anesthesia. Neonates delivered with epidural anesthesia scored lower than those delivered with spinal anesthesia on supporting reaction and motor activity at 2 hr of age (P < 0.05). All neonates had high scores at 24 hr, at which time there were no significant differences between the three groups.
Grupo terapeutico de apoyo dirigido a mujeres sobrevivientes de violencia intrafamiliar

es la desesperanza aprendida, ya que llegan a creer que no tienen ningun control sobre su situacion de violencia y que no pueden hacer nada para cambiarlo.Considerando lo anterior, fue de mucha importancia desarrollar un grupo terapeutico de apoyo dirigido hacia las necesidades de las mujeres sobrevivientes de VIF.Para su desarrollo se utilizo la perspectiva fenomenologica, el enfoque genero sensitivo, el enfoque humanistico, ademas de la metodologia cualitativa.El proceso grupal se oriento a explorar los ejes centrales de las areas afectadas por la VIF, a expresar sentimientos, a producir cambios cognoscitivos y conductuales, logrando el protagonismo de las miembras del grupo.Los enfoques utilizados en la terapia grupal de apoyo, hizo que se prestara gran atencion a las conductas, las ideas y las expresiones de cada mujer, lo que estimulo al grupo para que fueran las mismas participantes las que reconocieran las herramientas para enfrentar la situacion de violencia que viven.
Nutritional assessment of GI cancer patients at admission and seven days after major intraabdominal surgery

Pre-existing malnutrition has been reported to affect a high percentage of cancer patients. Various methods are being used to assess nutritional status in hospitalized patients. The aim of this study was to apply two different nutritional assessment techniques to determine the prevalence of malnutrition in GI cancer patients and to assess their nutritional status, at admission and seven days after surgery. For this purpose, the nutritional status of fifty one patients who underwent major intraabdominal surgery was assessed. The Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), anthropometric measurements, serum albumin, prealbumin, lymphocyte count and hematocrit were used to assess nutritional status of the patients. At the time of admission, based on the SGA and NRI, 70.6% and 74.5% of the patients were malnourished respectively. Both anthropometric and laboratory data, including weight, body mass index, mid arm circumference, triceps skin fold, mid arm muscle circumference, albumin, prealbumin, hematocrit and lymphocyte decreased significantly seven days after surgery (p<0.01). The malnutrition rates increased significantly to 98% with both the SGA and NRI, seven days after surgery (p<0.01). From the findings of this study it is concluded that there was a high prevalence of malnutrition in GI cancer patients and in almost all patients, nutritional status deteriorated seven days after surgery. Both methods proved useful for detection of the prevalence and development of malnutrition. Based on these results it is suggested that nutritional care after surgery should be improved by providing enough calories via enteral and/or parenteral route.
Validation of an equine inertial measurement unit system in clinically normal horses during walking and trotting.

OBJECTIVE To validate an equine inertial measurement unit (IMU) system rigidly attached to a hoof against a 3-D optical kinematics system in horses during walking and trotting. ANIMALS 5 clinically normal horses. PROCEDURES 5 swing phases of the hooves of the right forelimb and hind limb were collected via both 3-D optical and IMU systems from 5 horses during walking and trotting. Linear and angular positions, velocities, and accelerations were compared between the 2 systems. RESULTS Of the 55 variables compared between the 2 systems, 25 had high correlations (r > 0.8) and 18 had moderate correlations (r > 0.5). Root mean squared errors were lowest in the sagittal plane and orientation (1.1 to 4.4 cm over a range of 1.5 to 1.9 m in the cranial-caudal direction and 2.5° to 3.5° over a range of 88° to 110° rotating around the medial-lateral axis). There were more differences between the 2 systems during small changes in motion, such as in the medial-lateral and proximal-distal directions and in the angular measures around the cranial-caudal and proximal-distal axes. CONCLUSIONS AND CLINICAL RELEVANCE The equine IMU system may be appropriate for rigid attachment to a hoof of a horse and use in examination of linear and angular motion in the sagittal plane of the hoof during the swing phase while walking and trotting. Although promising in many respects, the IMU system cannot currently be considered clinically useful for lameness evaluation because of limitations in accuracy, attachment method, and lack of stance phase evaluation.
Renal effects of carprofen and etodolac in euvolemic and volume-depleted dogs.

OBJECTIVE To determine the effects of carprofen and etodolac on renal function in euvolemic dogs and dogs with extracellular fluid volume depletion induced via administration of furosemide. ANIMALS 12 female Beagles. PROCEDURES Dogs received a placebo, furosemide, carprofen, etodolac, furosemide and carprofen, and furosemide and etodolac. The order in which dogs received treatments was determined via a randomization procedure. Values of urine specific gravity, various plasma biochemical variables, glomerular filtration rate (GFR [urinary clearance of creatinine]), and renal plasma flow (urinary clearance of para-aminohippuric acid) were determined before and after 8 days of drug administration. A washout time of approximately 12 days was allowed between treatment periods. RESULTS Administration of furosemide, furosemide and carprofen, and furosemide and etodolac caused changes in urine specific gravity and values of plasma biochemical variables. Administration of carprofen or etodolac alone did not have a significant effect on renal plasma flow or GFR. Concurrent administration of furosemide and carprofen or furosemide and etodolac caused a significant decrease in GFR. After 12-day washout periods, mean values of GFR were similar to values before drug administration for all treatments. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated GFR decreased after 8 days of concurrent administration of furosemide and carprofen or furosemide and etodolac to dogs. Administration of preferential cyclooxygenase-2 inhibitors to dogs with extracellular fluid volume depletion or to dogs treated with diuretics may transiently impair renal function.
CT scan findings of emphysema predict mortality in COPD.

BACKGROUND Emphysematous change as assessed by CT imaging has been reported to correlate with COPD prognostic factors such as FEV(1) and diffusing capacity of the lung for carbon monoxide (Dlco). However, few studies have assessed the relationship between CT scan assessment and COPD mortality from mild to severe stages of the disease. In this study, we analyzed this relationship in patients with various stages of COPD. METHODS Two hundred and fifty-one outpatients with stable COPD were included in the study. CT scan and pulmonary function tests were performed at study entry in a single institution. The percentage of low attenuation area was measured to quantitatively evaluate emphysematous change with a custom-made software. Prognostic data also were collected, and the median follow-up time was 8 years. RESULTS Of the 251 patients, 79 died, with 40 classified as respiratory deaths not involving lung cancer. Univariate Cox analysis revealed that emphysematous change as assessed by CT scan, lung function, age, or BMI were significantly correlated with mortality. Multivariate analysis revealed that emphysematous change as assessed by CT scan had the best association with mortality. CONCLUSIONS Emphysematous change as assessed by CT scan predicts respiratory mortality in outpatients with various stages of COPD.
The Applicability and Usage of the International Classification of Functioning, Disability and Health (ICF) to Address Obesity Among U.S. Women

Background: Over the past two decades, obesity among women has significantly increased, with women having the highest prevalence in the United States. Obesity prevention programs and interventions focusing on women have traditionally included individual-level approaches although obesity is a multi-level problem. The research literature has cited numerous factors that contribute to obesity—behavioral, personal, psychological, sociodemographic, environmental, biological, and childbearing. As a result, recent public health efforts have shifted away from individual approaches to those that handle multiple factors. Methods: While multiple factors have been associated with obesity among women, the degree and variability of the factors have not been determined in the literature. These three studies seek to explore the effects of the multiple factors on BMI in U.S. women using the International Classification of Functioning, Disability and Health (ICF) Core Sets for Obesity, developed by the World Health Organization and data from the National Health and Nutrition Examination Survey (NHANES). Linear regression was used in the analyses. Results: Significant factors of obesity were sociodemographic information (age, income, and race), body weight perceptions, coexisting health conditions, physical functioning, and engaging in physical activity and proper nutritional practices.Conclusions: Obesity prevention and treatment programs for U.S. women should focus on the most significant factors identified in these studies to decrease obesity incidence and prevalence.Public Health Relevance: The information garnered from this study can be used to further identify the most important characteristics needed for future obesity prevention programs for women.