We applied the latent class analysis probabilities of profile membership developed from the derivation study to obtain symptom grouping , a-NIHSS item profiles .


We implemented an independent latent class analysis to derive secondary symptom grouping , b-NIHSS item profiles .


Validation was performed by assessing the associations with outcomes and evaluating both sets of NIHSS item profiles ' discrimination and calibration to the data .


The outcomes evaluated included modified Rankin Scale ( mRS ; using the full distribution and dichotomized , mRS , @-@ ) at day @ and mortality by @ days .


We identified @ @ patients .


Ordinal analysis of mRS confirmed increased odds of better outcome across the profiles in a stepwise manner , adjusted for age and thrombolysis treatment , for each set of NIHSS item profiles .


Similar patterns were observed for mRS @ to @ , and inverse patterns were seen for mortality .


The c-statistics of a-NIHSS and b-NIHSS item profiles for mRS @ to @ were similar at @ ( @ % confidence interval , @-@ @ ) and for mortality , @ ( @-@ @ ) and @ ( @-@ @ ) , respectively .


Calibration was good .


These NIHSS item profiles identified using latent class analysis offer a reliable approach to capture the true response patterns that are associated with functional and outcome and mortality post stroke .


This approach has the potential to enhance the clinical value of the overall NIHSS score .


The current study was undertaken to investigate the efficacy and safety of erlotinib versus pemetrexed as second-line therapy for patients with advanced epidermal growth factor receptor ( EGFR ) wild-type and EGFR fluorescence in situ hybridization ( FISH ) - positive lung adenocarcinoma .


In this open-label , randomized , phase @ study , patients with EGFR wild-type and EGFR FISH-positive adenocarcinoma who had developed disease progression after @ prior platinum-based chemotherapy were randomly assigned ( @:@ ) to receive erlotinib or pemetrexed until the time of disease progression or death , unacceptable toxicity , or a request for discontinuation by the patient .


The primary endpoint was progression-free survival ( PFS ) .


A total of @ patients were enrolled ( @ in the erlotinib arm and @ in the pemetrexed arm ) .


The median PFS was @ months ( @ % confidence interval -LSB- @ % CI -RSB- , @ months-@ @ months ) in the erlotinib group versus @ months ( @ % CI , @ months-@ @ months ) in the pemetrexed group .


The difference in PFS between the @ treatment groups was not significant ( hazard ratio , @ ; @ % CI , @-@ @ -LSB- P = @ -RSB- ) .


The objective response rate appeared to be higher among patients receiving erlotinib compared with those receiving pemetrexed ( @ % vs @ % ; P = @ ) .


The @ most commonly recorded adverse events were rash ( @ % ) , fatigue ( @ % ) , and diarrhea ( @ % ) in the erlotinib group and fatigue ( @ % ) , nausea ( @ % ) , and anorexia ( @ % ) in the pemetrexed group .


There were no significant differences noted with regard to efficacy between erlotinib and pemetrexed in the second-line setting for patients with advanced EGFR wild-type and EGFR FISH-positive lung adenocarcinoma .


Both regimens appear to be effective treatment options for these patients .


To examine the impact of a weight loss intervention upon follicle stimulating hormone ( FSH ) levels in postmenopause .


Participants were postmenopausal , overweight , glucose-intolerant women not using exogenous estrogen ( n = @ ) in the Diabetes Prevention Program .


Women were randomized to intensive lifestyle change ( ILS ) with the goals of weight reduction of at least @ % of initial weight and @ min per week of moderate-intensity exercise , metformin @ mg twice a day , or placebo administered twice a day .


Randomization to ILS led to small increases in FSH between baseline and @-year follow-up vs. placebo ( @ IU/l vs. -@ IU/l , P < @ ) .


Increases in FSH were correlated with decreases in weight ( r = -@ , P < @ ) and estradiol ( E@ ) ( r = -@ , P < @ ) after adjustment for age , race/ethnicity , and randomization arm .


Changes in FSH were still significantly associated with changes in weight even after adjustment for E@ levels .


Metformin users had reductions in weight but non-significant changes in FSH and E@ levels vs. placebo .


Weight loss leads to small increases in FSH among overweight , postmenopausal women , potentially through pathways mediated by endogenous estrogen as well as other pathways .


Low levels of physical activity ( PA ) are associated with poor outcomes in people with COPD .


Interventions to increase PA could improve outcomes .


We tested the efficacy of a novel Internet-mediated , pedometer-based exercise intervention .


Veterans with COPD ( N = @ ) were randomized in a @:@ ratio to the ( @ ) intervention group ( Omron HJ-@ ITC pedometer and Internet-mediated program ) or ( @ ) wait-list control group ( pedometer ) .


The primary outcome was health-related quality of life ( HRQL ) , assessed by the St. George 's Respiratory Questionnaire ( SGRQ ) , at @ months .


We examined the SGRQ total score ( SGRQ-TS ) and three domain scores : Symptoms , Activities , and Impact .


The secondary outcome was daily step counts .


Linear regression models assessed the effect of intervention on outcomes .


Participants had a mean age of @ @ years , and @ % were men .


There was no significant between-group difference in mean @-month SGRQ-TS ( @ units , P = @ ) .


Nevertheless , a significantly greater proportion of intervention participants than control subjects had at least a @-unit improvement in SGRQ-TS , the minimum clinically important difference ( @ % vs @ % , respectively , P = @ ) .


For domain scores , the intervention group had a lower ( reflecting better HRQL ) mean than the control group by @ units for Symptoms ( P = @ ) and by @ units for Impact ( P = @ ) .


There was no significant difference in Activities score between the two groups .


Compared with the control subjects , intervention participants walked @ more steps per day at @ months ( P = @ ) .


An Internet-mediated , pedometer-based walking program can improve domains of HRQL and daily step counts at @ months in people with COPD .


To determine the effects of cognitive training on cognitive abilities and everyday function over @ years .


Ten-year follow-up of a randomized , controlled single-blind trial ( Advanced Cognitive Training for Independent and Vital Elderly ( ACTIVE ) ) with three intervention groups and a no-contact control group .


Six U.S. cities .


A volunteer sample of @,@ persons ( mean baseline age @ ; @ % African American ) living independently .


Ten training sessions for memory , reasoning , or speed of processing ; four sessions of booster training @ and @ months after initial training .


Objectively measured cognitive abilities and self-reported and performance-based measures of everyday function .


Participants in each intervention group reported less difficulty with instrumental activities of daily living ( IADLs ) ( memory : effect size = @ , @ % confidence interval ( CI ) = @-@ @ ; reasoning : effect size = @ , @ % CI = @-@ @ ; speed of processing : effect size = @ , @ % CI = @-@ @ ) .


At a mean age of @ , approximately @ % of trained participants , versus @ % of controls ( P < @ ) , were at or above their baseline level of self-reported IADL function at @ years .


The reasoning and speed-of-processing interventions maintained their effects on their targeted cognitive abilities at @ years ( reasoning : effect size = @ , @ % CI = @-@ @ ; speed of processing : effect size = @ , @ % CI = @-@ @ ) .


Memory training effects were no longer maintained for memory performance .


Booster training produced additional and durable improvement for the reasoning intervention for reasoning performance ( effect size = @ , @ % CI = @-@ @ ) and the speed-of-processing intervention for speed-of-processing performance ( effect size = @ , @ % CI = @-@ @ ) .


Each Advanced Cognitive Training for Independent and Vital Elderly cognitive intervention resulted in less decline in self-reported IADL compared with the control group .


Reasoning and speed , but not memory , training resulted in improved targeted cognitive abilities for @ years .


Attention deficits are often among the most persistent and debilitating impairments resulting from traumatic brain injury ( TBI ) .


This study examined the effects of lisdexamfetamine dimesylate ( Vyvanse ) in treating attention deficits due to moderate-to-severe TBI .


It was the first study of lisdexamfetamine dimesylate with this population and , in fact , was the first controlled trial in this area examining a stimulant medication option other than methylphenidate .


This was a @-week , randomized , double-blind , placebo-controlled , cross-over trial .


A total of @ rigorously selected cases were enrolled , @ of whom completed the trial .


They were @-@ years of age and had newly acquired attention deficits persisting for @-@ months post-injury .


They were assessed on a broad range of neuropsychological and behavioural measures at baseline , @-weeks and at @-weeks .


Positive treatment effects were found involving selective measures of sustained attention , working memory , response speed stability and endurance and in aspects of executive functioning .


No major problems with safety or tolerability were observed .


Some moderating treatment effects were found from a broad range of pre-treatment subject characteristics and injury variables examined .


Avenues for further research and treatment applications in this area are discussed .


Extended sitting time at work is viewed as a crucial public health issue .


Encouraging workers to stand during their office hours via the installation of standing desks maybe one effective option to combat this .


Here , we investigate whether the installation of high desks in the workplace can induce positive changes in the amount of physical activity ( PA ) and thereby lead to subsequent improvements in anthropometric parameters .


Thirty-two white-collar workers ( @ men and @ women , mean age @ ) were randomly divided into two groups .


A randomised crossover trial was performed for @ weeks .


During the experimental period , subjects completed their office work in a standing position using stationary high desks ( standing work , SW ) for @ hours per week or more ( SW period ) .


The subjects were asked to maintain their normal sitting working habits during the control period ( CONT period ) .


The primary outcome was PA , which was assessed objectively using a triaxial accelerometer during weekdays and weekends .


The secondary outcomes were anthropometric measurements .


For each group and each parameter , the mean values during each period were recorded and were compared by paired t test .


The daily total PA ( @ @ vs. @ @ METs h/day , P = @ ) , MVPA ( @ @ vs. @ @ METs h/day , P = @ ) , time spent in moderate PA ( @ @ vs. @ @ min/day , P = @ ) and time spent in MVPA ( @ @ vs. @ @ min/day , P = @ ) were significantly higher during the SW period compared to the CONT period .


A weekdays verses weekends subanalysis revealed that these parameters were significantly higher during the SW period compared to the CONT period during weekdays only .


No significant differences were noted before and after SW periods for most of the anthropometric measures , except waist circumference ( @ @ vs. @ @ cm , respectively , P = @ ) .


Standing work , via the installation of high desks , significantly increases moderate to vigorous physical activity , especially on weekdays .


The aims of this study were to investigate the short-term benefit of etanercept ( ETN ) + MTX vs conventional synthetic DMARDs ( csDMARDs ; HCQ , LEF or SSZ ) + MTX in subjects with established RA .


The effect of disease duration ( @ years vs > @ years ) and severity ( moderate vs severe ) on treatment outcomes was also assessed .


Methods .


Data from Asian and Latin American subjects with inadequate response to MTX were pooled from the APPEAL ( ETN @ mg biweekly + MTX or csDMARD + MTX ; NCT@ ) and Latin RA ( ETN @ mg/week + MTX or csDMARD + MTX ; NCT@ ) studies .


Endpoints included the @-joint DAS with ESR ( DAS@-ESR ) low disease activity ( LDA ; @ ) , DAS@ remission ( < @ ) and HAQ score @ .


Four hundred seventy-eight subjects received ETN + MTX , @ subjects received csDMARD + MTX -LSB- HCQ + MTX ( n = @ ) , LEF + MTX ( n = @ ) , SSZ + MTX ( n = @ ) -RSB- .


At week @ , significantly more subjects receiving ETN + MTX vs subjects on csDMARDs + MTX achieved DAS@-ESR LDA ( @ % vs @ % , P < @ ) , remission ( @ % vs @ % , P < @ ) and HAQ @ ( @ % vs @ % , P < @ ) .


For both treatment arms , these endpoints were achieved by a greater proportion of subjects with @ years vs > @ years disease duration and with moderate vs severe disease activity .


Overall , ETN + MTX was more effective in treating subjects with established RA than csDMARDs + MTX at @ weeks .


More subjects with shorter disease duration and moderate disease activity achieved optimal response regardless of treatment regimen .


The National Emphysema Treatment Trial ( NETT ) was a randomized clinical trial designed to compare lung volume reduction surgery ( LVRS ) with maximal medical care for patients with severe emphysema .


The trial was halted early for a subgroup of patients with severe lung disease .


We report longer term follow-up for this high-risk subgroup .


In a randomized clinical trial , patients with moderate to severe emphysema were assigned to LVRS plus maximal medical care or to maximal medical care alone and followed prospectively for vital status over @ years .


We focus on @ high-risk patients .


Quality of life data were available through @ years of follow-up and were assessed using the University of California , San Diego Shortness of Breath Questionnaire and the Self-Administered Quality of Well-Being Scale .


Through the first @ years of follow-up , surgical patients in the high-risk subgroup had a significantly higher probability of death .


However , the mortality curves crossed and there was a trend favoring surgical treatment through the remainder of the follow-up .


The log-rank test suggested that the @ groups were not significantly different ( p = @ ) in survival .


Quality of life data suggested an advantage of LVRS through the first @ years of follow-up ( p < @ ) .


The combined quality-adjusted survival model favored the medical group for the first few years of follow-up and favored the LVRS group after @ years .


The NETT was stopped early for high-risk patients with severe lung disease .


Longer term follow-up suggests that surgical patients in this high-risk subgroup ultimately achieved comparable outcomes .


The high risk of death within @ days of the surgery may discourage use of the procedure for high-risk patients despite the potential for better long-term outcomes .


Docosahexaenoic acid ( DHA ) accumulates in the hippocampus and frontal lobes of the fetal brain during the last trimester of pregnancy .


These areas of the brain contribute to attention and working memory and inhibitory control ( WMIC ) .


We evaluated the effect of maternal omega-@ ( n-@ ) long-chain polyunsaturated fatty acid supplementation in pregnancy on child attention and WMIC .


A total of @ term-born children of mothers who were randomly allocated to consume @ mg DHA/d ( treatment ) or a placebo ( control ) from @ wk of gestation until birth were assessed with multiple measures of attention and WMIC at a mean ( SD ) of @ @ mo. .


Primary outcomes were the average time it took to be distracted when playing with a toy ( distractibility ) and the accuracy of remembering a new hiding location while inhibiting a learned response to search in the previous location ( WMIC ) .


Assessments were completed by @ children in the treatment group ( mean SD age : @ @ d ) and @ children in the control group ( @ @ d ) .


There was no effect of supplementation on primary outcomes -LSB- distractibility mean difference : -@ s ( @ % CI : -@ , @ s ) ; WMIC mean difference : @ mm ( @ % CI : -@ , @ mm ) -RSB- .


There was no difference between DHA-supplemented and control groups except that treatment-group children looked away from the toys fewer times than controls when presented with multiple toys competing for attention but less accurately remembered a repeated hiding location .


These secondary effects were not consistent with any other outcomes and may have been a result of chance .


Cord plasma DHA was not consistently associated with attention and WMIC .


Maternal DHA supplementation during pregnancy does not enhance attention or WMIC in term-born preschoolers .


The DHA for Maternal and Infant Outcomes trial was registered at www.anzctr.org.au as ACTRN@ .


Oral steroids are commonly used to treat acute sciatica due to a herniated disk but have not been evaluated in an appropriately powered clinical trial .


To determine if oral prednisone is more effective than placebo in improving function and pain among patients with acute sciatica .


Randomized , double-blind , placebo-controlled clinical trial conducted from @ to @ in a large integrated health care delivery system in Northern California .


Adults ( n = @ ) with radicular pain for @ months or less , an Oswestry Disability Index ( ODI ) score of @ or higher ( range , @-@ ; higher scores indicate greater dysfunction ) , and a herniated disk confirmed by magnetic resonance imaging were eligible .


Participants were randomly assigned in a @:@ ratio to receive a tapering @-day course of oral prednisone ( @ days each of @ mg , @ mg , and @ mg ; total cumulative dose = @ mg ; n = @ ) or matching placebo ( n = @ ) .


The primary outcome was ODI change at @ weeks ; secondary outcomes were ODI change at @ year , change in lower extremity pain ( measured on a @-@ scale ; higher scores indicate more pain ) , spine surgery , and Short Form @ Health Survey ( SF-@ ) Physical Component Summary ( PCS ) and Mental Component Summary ( MCS ) scores ( @-@ scale ; higher scores better ) .


Observed baseline and @-week mean ODI scores were @ and @ for the prednisone group and @ and @ for the placebo group , respectively .


The prednisone-treated group showed an adjusted mean @-point ( @ % CI , @-@ @ ; P = @ ) greater improvement in ODI scores at @ weeks than the placebo group and a mean @-point ( @ % CI , @-@ @ ; P = @ ) greater improvement at @ weeks .


Compared with the placebo group , the prednisone group showed an adjusted mean @-point ( @ % CI , -@ to @ ; P = @ ) greater reduction in pain at @ weeks and a mean @-point ( @ % CI , -@ to @ ; P = @ ) greater reduction at @ weeks .


The prednisone group showed an adjusted mean @-point ( @ % CI , @-@ @ ; P = @ ) greater improvement in the SF-@ PCS score at @ weeks , no difference in the SF-@ PCS score at @ weeks ( mean , @ ; @ % CI , -@ to @ ; P = @ ) , no change in the SF-@ MCS score at @ weeks ( mean , @ ; @ % CI , -@ to @ ; P = @ ) , and an adjusted @-point ( @ % CI , @-@ @ ; P = @ ) greater improvement in the SF-@ MCS score at @ weeks .


There were no differences in surgery rates at @-week follow-up .


Having @ or more adverse events at @-week follow-up was more common in the prednisone group than in the placebo group ( @ % vs @ % ; P < @ ) .


Among patients with acute radiculopathy due to a herniated lumbar disk , a short course of oral steroids , compared with placebo , resulted in modestly improved function and no improvement in pain .


Abdominal sepsis is associated with varied degree of hypoxemia and atelactasis in the lung and can enhance the onset of desaturation of arterial blood during apnea .


This study looked at methods to improve safety margin of apnea during induction of anesthesia in these high-risk patients .


It was a randomized , single blind study on adult patients presenting for emergency laparotomy due to peritonitis in a university teaching hospital setting .


In group @ ( IS ) ( n = @ ) , three sessions of incentive spirometry ( IS ) were performed within one hour before induction of anesthesia .


In group @ ( DB ) ( n = @ ) , patients were subjected to deep breathing sessions in a similar manner .


All patients received preoxygenation ( @ % ) by mask for @ min , followed by rapid-sequence induction of anesthesia using fentanyl , thiopental , and suxamethonium and endotracheal intubation .


Patients were subjected to a period of apnea by keeping the end of the endotracheal tube open to air till they developed @ % hemoglobin saturation ( SpO @ ) by pulse oxymetry .


Positive pressure ventilation was resumed at the end .


We observed for hemodynamic changes , apnea time , and SpO @ ( @ % ) recovery time on resuming ventilation .


Arterial blood gas samples were taken before intervention , after IS or DB , after preoxygenation , and at the end of apnea .


One-way analysis of variance ( ANOVA ) , X @ test , Kaplan-Meier graph , and log-rank tests were applied to compare the two study groups .


Oxygenation level in group @ ( @ @ mmHg ) patients was significantly ( P < @ ) higher than in group @ ( @ @ mmHg ) at the end of preoxygenation .


The apnea time ( median : lower bound - upper bound Confidence Interval apnea time ) ( @:@ -@ s ) in group @ ( IS ) patients was significantly higher P < @ ) than in group @ ( @:@ -@ s ) patients .


Saturation recovery time ( @:@ -@ s ) in group @ ( IS ) patients was also quicker than in group @ patients ( @:@ -@ s ) .


IS in the preoperative period is superior to deep breathing sessions for improving apnea tolerance during induction of anesthesia in abdominal sepsis patients .


Amino acid ( AA ) metabolism is altered in type @ diabetes ( T@D ) , and fasting levels of - hydroxybutyrate ( - HB ) , a biomarker for insulin resistance , have been suggested to track AA metabolism .


We investigated the changes in AA and - HB induced by a mixed-meal tolerance test ( MTT ) and the effects of sitagliptin treatment .


Forty-seven T@D patients -LSB- @ @ years , body mass index ( BMI ) @ @ kg/m ( @ ) -RSB- were randomized to sitagliptin ( @ mg/day , @ weeks ) or placebo .


Seven age - and BMI-matched non-diabetic subjects served as control ( CT ) .


During a @-h MTT , branched-chain AA ( BCAA ) peaked earlier in T@D than CT -LSB- @ ( @ ) vs. @ ( @ ) mmol/l h over @ h , median ( interquartile range ) , p = @ -RSB- , and rose higher -LSB- @-h increment : @ ( @ ) vs. @ ( @ ) mmol/l h , p = @ -RSB- .


Fasting - HB was higher -LSB- @ ( @ ) vs. @ ( @ ) g/ml , p = @ T@D vs. CT -RSB- , and its meal-induced increments were larger -LSB- @ ( @ ) vs. -@ ( @ ) g/ml h , p = @ -RSB- .


Plasma non-esterified fatty acids ( NEFA ) declined during MTT , but their increments were greater in patients ( @ @ vs. @ @ mEq/l h , p = @ ) .


Compared to placebo , both BCAA -LSB- -@ ( @ ) vs. @ ( @ ) mmol/l h , p = @ -RSB- and - HB increments -LSB- -@ ( @ ) vs. @ ( @ ) g/ml h , p = @ -RSB- decreased with sitagliptin , and meal-induced NEFA suppression was improved .


Changes in BCAA and - HB were reciprocally related to changes in insulin sensitivity ( = -@ and -@ , p @ ) .


T@D is associated with a hyperaminoacidaemic response to MTT , which circulating - HB levels track .


Sitagliptin-induced glycaemic improvement was associated with reductions in BCAA and - HB excursions and better NEFA suppression , in parallel with improved insulin sensitivity , confirming that - HB is a readout of metabolic overload .


Cardiac resynchronization therapy ( CRT ) improves hemodynamic function , as well as reduces hospitalizations and mortality among patients with systolic dysfunction , QRS prolongation , and heart failure .


The magnitude of the hemodynamic response is associated with improved outcomes , so optimization of this parameter is a goal of therapy .


The purpose of this study was to evaluate the effect of left ventricular ( LV ) electrical delay , as assessed by the QLV interval , on the acute hemodynamic response to CRT .


This study included @ patients undergoing biventricular ICD placement .


At implant , invasive LV dP/dt was measured by a micromanometer catheter during biventricular ( BV ) or LV only pacing .


Both atrial sensing ( AS ) and atrial pacing ( AP ) modes were evaluated at @ different AV delays , tested in randomized order .


The QLV interval was measured at the LV pacing site .


Compared with intrinsic rhythm , CRT increased LV dP/dtmax by @ @ % with BV pacing and @ @ % with LV pacing ( P = @ ) during AS .


With AP , CRT increased LV dP/dtmax by @ @ % and @ @ % , respectively ( P = @ ) .


QLV was strongly correlated with the hemodynamic response in all pacing configurations .


Multivariate analysis showed that with BV pacing QLV was an independent predictor of the hemodynamic response with a @ % increase in % LV dP/dt for every @ milliseconds prolongation of QLV .


LV electrical delay is a strong predictor of the acute hemodynamic response to CRT .


This relationship is independent of pacing mode .


The quality of life depends on physical , psychological and social factors that are evidently influenced by the individual 's actions , prospect , attitude and behavior .


Heart disease is one of the most imperative health problems in the world .


Studies showed that exercise-based rehabilitation for patients with coronary artery disease effectively lowers the rate of cardiac death .


The intent of this study was to determine the effects of physical activity on the life quality of cardiovascular patients after coronary artery bypass graft .


This randomized clinical trial was performed on two groups of coronary artery patients of Yazd Afshar hospital .


All the @ participants were post surgery coronary artery patients who were divided into two groups .


Data was collected by two questionnaires : A personal information questionnaire and a quality of life questionnaire ( SF = @ ) .


Data of both groups was collected in the first and fourth month after the discharge from surgery and sessions were analyzed by SPSS @ and by using T-test and Chi-square .


Results displayed that after the intervention , all the categories of the components of the quality of life were increased except for general health .


There was no significant differentiation between these statuses in the control group and the premier grades about the components of the social function ( @ out of @ ) .


The comparison of total scores of the quality of life before the intervention showed the quality of life of both groups one month after surgery was not significant ( p = @ % ) , but in four months after surgery , the distinction between the mean grade scores of the intervention , the group was considerable ( p = @ ) .


The comparison of the total scores of the quality of life indicated an increase in the scores of the quality of life in the intervention group after the exercise .


There is extensive evidence of health inequality across ethnic groups .


Inequity is a complex social phenomenon involving several underlying factors , including ethnic discrimination .


In the field of health care , it has been established that ethnic discrimination stems partially from bias or prejudice on the part of doctors .


Indeed , it has been hypothesized that patient ethnicity may affect doctors ' social cognition , thus modifying their social interactions and decision-making processes .


General practitioners ( GPs ) are the primary access point to health care for ethnic minority groups .


In this study , we examine whether patient ethnicity affects the relational and decisional features of doctoring .


The sample was made up of @ Belgian GPs , who were each randomly allocated to one of two experimental conditions .


One group were given a hypertension vignette case with a Belgian patient ( non-minority patient ) , while the other group were given a hypertension vignette case with a Moroccan patient ( minority patient ) .


We evaluated the time devoted by GPs to examining medical history ; time devoted by GPs to examining socio-relational history ; cardiovascular risk assessments by GPs ; electrocardiogram ( ECG ) recommendations by GPs , and drug prescriptions by GPs .


We observed that for ethnic minority patients , GPs prescribed more drugs and devoted less time to examining socio-relational history .


Neither cardiovascular risk assessments nor ECG recommendations were affected by patient ethnicity .


GPs who were very busy devoted less time to examining medical history when dealing with minority patients .


We found no evidence that GPs discriminated against ethnic minority patients when it came to medical decisions .


However , our study did identify a risk of drugs being used inappropriately in some ethnic-specific encounters .


We also observed that , with ethnic minority patients , GPs engage less in the relational dimension of doctoring , particularly when working within a demanding environment .


In general practice , the quality of the relationship between doctor and patient is an essential component of the effective management of chronic illness .


Our research highlights the complexity of ethnic discrimination in general practice , and the need for further studies .


To observe the clinical effect of acupuncture on acute heart failure ( AHF ) patients .


Totally @ patients who were diagnosed as AHF were assigned to the acupuncture group and the control group , @ in each group .


Those in the control group received inotropic agents , preload and afterload reducing therapy , anti-infection and so on .


Besides , those in the acupuncture group received needling at relative points , once daily for @ consecutive days .


The mean arterial pressure ( MAP ) , heart rate ( HR ) , cardiac index ( CI ) , stroke volume index ( SI ) , left ventricle working index ( LCWI ) were monitored by thermodilution pulse-indicated continuous cardiac output ( PiCCO ) technique .


Changes of the aforesaid data were compared between before and after treatment .


The ICU length of stay , readmission rate , and the @-day mortality were also compared between the two groups .


After @ days of the treatment , CI , SI , and LCWI increased more obviously ( P < @ ) , HR and MAP decreased significantly ( P < @ ) .


Of them , CI , SI , and LCWI increased more obviously in the acupuncture group ( P < @ ) .


There was no obvious difference in HR or MAP between the two groups ( P > @ ) .


Compared with the first day of admission in the same group , CI , SI , and LCWI obviously increased in the acupuncture group from the second day ( P < @ ) .


HR started to decrease since the fourth day ( P < @ ) , and MAP began to decrease until the fifth day ( P < @ ) .


CI , SI , and LCWI started to increase in the control group from the third day ( P < @ ) ; HR and MAP both began to decrease since the fifth day ( P < @ ) .


Compared with the control group , the ICU length of stay was obviously shortened in the acupuncture group ( P < @ ) .


The readmission rate and the @-day mortality rate were lower than those of the control group ( P < @ ) .


The combination of acupuncture and Western medical therapy might strengthen acute heart failure patients ' heart functions , elevate the therapeutic effect , and improve the prognosis .


To explore the effect of acupuncture at HT@ on heart rate variability ( HRV ) in healthy volunteers .


@ subjects were divided into four groups using a random number table .


The following groups of acupuncture interventions were used : HT@ verum acupuncture ; HT@ non-penetrating sham acupuncture ; acupuncture at a sham point ; and no acupuncture .


HRV was recorded @min before , during and after each stimulation using an Actiheart ECG recorder .


The HT@ verum acupuncture group had higher very-low frequency , low frequency and high frequency components of HRV compared with the control groups during but not after acupuncture .


The HT@ verum acupuncture group also had higher SD of normal intervals compared with the sham needling and no acupuncture control groups .


Our preliminary study suggests , subject to limitations , that acupuncture at HT@ could affect cardiac autonomic neural regulation in healthy subjects , manifest as increased HRV , most likely via the parasympathetic system .


Intraoperative radiation therapy ( IORT ) is an emerging option for partial breast radiotherapy in select women with early stage breast cancer .


We assessed short-term clinical and sonographic findings after breast conservation ( BCT ) and IORT .


An IRB-approved , single institution retrospective chart review was conducted of patients ( pts ) treated with BCT/IORT from @/@ to @/@ .


Follow-up clinical breast exams and ultrasounds ( US ) obtained @ and @ months after BCT/IORT were retrospectively reviewed by a single breast radiologist ( JD ) for sonographic findings .


P values were calculated using McNemar 's test , Wilcoxon Rank Sum Test , and Chi-square .


Seventy-one pts underwent BCT/IORT and @ pts had an US .


All @ pts had a seroma , @/@ ( @ % ) pts were symptomatic .


Eighteen pts had deep tissue closure ( DTC ) of the lumpectomy cavity with @/@ ( @ % ) DTC pts being symptomatic at follow-up versus @/@ ( @ % ) without DTC ( P = @ ) .


At @ months , DTC resulted in smaller seroma cavity volumes compared to those without DTC ( P = @ ) .


Presence of a seroma is commonplace post BCT/IORT ; symptomatic seromas are uncommon .


DTC generated smaller seromas .


Longer follow-up with serial US performed in all BCT/IORT pts could be considered to document natural progression/regression of symptoms and seromas .


To evaluate the sustained efficacy of @-year sublingual immunotherapy ( SLIT ) and @ year after @-year SLIT in children with allergic rhinitis ( AR ) .


This study is a randomized , open and prospective trial .


One hundred twenty children ( between @ and @ years old ) suffering from AR duo to mite were chosen from November , @ to June , @ in department of otolaryngology in our hospital divided into two groups : @ underwent @-year course of SLIT and one year follow-up combined with @-year drug therapy as SLIT group ; @ received only drug therapy as control group .


The patients were evaluated at three time points ( baseline , end of SLIT and @ year after SLIT discontinuation ) regarding symptom scores including total nasal symptom score ( TNSS ) , sneezing , rhinorrhoea , nasal obstruction , nasal itching and total medication scores ( TMS ) and adverse reaction .


( @ ) At the end of SLIT , the symptom scores excepting sneezing and total medication scores in SLIT group are obviously lower than those in control group ( P < @ ) .


At @ year after SLIT discontinuation , all of the score including sneezing ( P < @ ) in SLIT group are lower than those of control group .


( @ ) At the end of SLIT and @ year after SLIT discontinuation , all of the scores are lower than those at baseline in SLIT group ( P < @ ) ; the scores were no different in SLIT group between the end of SLIT and @ year after SLIT discontinuation ( P > @ ) .


But at the end of SLIT and @ year after SLIT discontinuation , TMS was higher than it at baseline in control group ( P < @ ) .


At @ year after SLIT discontinuation , nasal obstruction score was higher than it at baseline ( P < @ ) .


SLIT can obviously improve the AR and the efficacy can sustain after @-year SLIT discontinua tion .


Drug increased in @ years without SLIT .


This report summarizes the first studies on individual placement and support ( IPS ) in the field of physical medicine and rehabilitation ( PM&R ) and discusses adaptation of the model .


Research related to the implementation and evaluation of the use of IPS in the VA System of Spinal Cord Injury Care is reviewed .


Results suggest that IPS was more effective than traditional vocational rehabilitation .


With physical disabilities , the model needs adaptation with respect to integration , disclosure , and job development while following the core principles .


Special consideration is needed with respect to caseload size and transportation issues .


Published results from the Spinal Cord Injury Vocational Integration Program ( SCI-VIP ) study and clinical field observations .


IPS can be successfully adapted to physical medicine and rehabilitation .


To compare functional outcomes of @-year-old ( school-age ) children born small for gestational age ( SGA ; ie , a birth weight z score -@ SD ) , with appropriate for gestational age ( AGA ) peers , born moderately preterm or full term .


Data were collected as part of the Longitudinal Preterm Outcome Project study , a community-based , prospective cohort study of @ AGA and @ SGA born children ( median gestational age @ weeks , range @-@ ) .


Of the SGA children , @ were moderately preterm , @ were full term ; of the AGA , these numbers were @ and @ , respectively .


At @ years , we assessed intelligence , verbal memory , attention , visuomotor integration , and motor skills and we collected the parent-reported executive functioning .


We compared the outcomes of the SGA children with those of their AGA peers .


The performance of SGA children was similar to that of their AGA peers , except for attention control which was abnormal more often in SGA children ( OR @ , @ % CI @-@ @ ) .


The IQ of SGA children was @ points lower , but this difference failed to reach significance .


At school age , children born SGA have a greater risk of abnormal test scores on attention control than children born AGA , independent of gestational age .


Their motor and many other cognitive functions are similar .


The impact of these outcomes seems limited .


Nevertheless , the consequences for school performance deserve attention .


The aim of this study was to compare high-flow nasal cannula ( HFNC ) and conventional O@ therapy ( OT ) in paediatric cardiac surgical patients ; the primary objective of the study was to evaluate whether HFNC was able to improve PaCO@ elimination in the first @ h after extubation postoperatively .


We conducted a randomized , controlled trial in pediatric cardiac surgical patients under @ months of age .


At the beginning of the weaning of ventilation , patients were randomly assigned to either of the following groups : OT or HFNC .


Arterial blood samples were collected before and after extubation at the following time points : @ , @ , @ , @ and @ h.


The primary outcome was comparison of arterial PaCO@ postextubation ; secondary outcomes were PaO@ and PaO@/fractional inspired oxygen ( FiO@ ) ratio , rate of treatment failure and need of respiratory support , rate of extubation failure , rate of atelectasis , simply to complications and the length of paediatric cardiac intensive care unit stay .


Demographic and clinical variables were comparable in the two groups .


Analysis of variance for repeated measures showed that PaCO@ was not significantly different between the HFNC and OT groups ( P = @ ) , whereas PaO@ and PaO@/FiO@ were significantly improved in the HFNC group ( P = @ and P = @ ) .


The rate of reintubation was not different in the two groups ( P = @ ) , whereas the need for noninvasive respiratory support was @ % in the OT group and none in the HFNC group ( P = @ ) .


HFNC had no impact on PaCO@ values .


The use of HFNC appeared to be safe and improved PaO@ in paediatric cardiac surgical patients .


In contrast to conventional ( CONV ) neuromuscular electrical stimulation ( NMES ) , the use of `` wide-pulse , high-frequencies '' ( WPHF ) can generate higher forces than expected by the direct activation of motor axons alone .


We aimed at investigating the occurrence , magnitude , variability and underlying neuromuscular mechanisms of these `` Extra Forces '' ( EF ) .


Electrically-evoked isometric plantar flexion force was recorded in @ healthy subjects .


Additionally , twitch potentiation , H-reflex and M-wave responses were assessed in @ participants .


CONV ( @Hz , @ ms ) and WPHF ( @Hz , @ms ) NMES consisted of five stimulation trains ( @s on-@s off ) .


K-means clustering analysis disclosed a responder rate of almost @ % .


Within this group of responders , force significantly increased from @ % to @ % of the maximal voluntary contraction force and H-reflexes were depressed after WPHF NMES .


In contrast , non-responders showed neither EF nor H-reflex depression .


Twitch potentiation and resting EMG data were similar between groups .


Interestingly , a large inter - and intrasubject variability of EF was observed .


The responder percentage was overestimated in previous studies .


This study proposes a novel methodological framework for unraveling the neurophysiological mechanisms involved in EF and provides further evidence for a central contribution to EF in responders .


There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography ( CT ) or ultrasonography .


In this multicenter , pragmatic , comparative effectiveness trial , we randomly assigned patients @ to @ years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician ( point-of-care ultrasonography ) , ultrasonography performed by a radiologist ( radiology ultrasonography ) , or abdominal CT. .


Subsequent management , including additional imaging , was at the discretion of the physician .


We compared the three groups with respect to the @-day incidence of high-risk diagnoses with complications that could be related to missed or delayed diagnosis and the @-month cumulative radiation exposure .


Secondary outcomes were serious adverse events , related serious adverse events ( deemed attributable to study participation ) , pain ( assessed on an @-point visual-analogue scale , with higher scores indicating more severe pain ) , return emergency department visits , hospitalizations , and diagnostic accuracy .


A total of @ patients underwent randomization : @ to point-of-care ultrasonography , @ to radiology ultrasonography , and @ to CT. .


The incidence of high-risk diagnoses with complications in the first @ days was low ( @ % ) and did not vary according to imaging method .


The mean @-month cumulative radiation exposure was significantly lower in the ultrasonography groups than in the CT group ( P < @ ) .


Serious adverse events occurred in @ % of the patients assigned to point-of-care ultrasonography , @ % of those assigned to radiology ultrasonography , and @ % of those assigned to CT ( P = @ ) .


Related adverse events were infrequent ( incidence , @ % ) and similar across groups .


By @ days , the average pain score was @ in each group ( P = @ ) .


Return emergency department visits , hospitalizations , and diagnostic accuracy did not differ significantly among the groups .


Initial ultrasonography was associated with lower cumulative radiation exposure than initial CT , without significant differences in high-risk diagnoses with complications , serious adverse events , pain scores , return emergency department visits , or hospitalizations .


( Funded by the Agency for Healthcare Research and Quality . )


Emerging evidence suggests modulating the microbiota in the large bowel of patients with chronic kidney disease ( CKD ) through pre - and/probiotic supplementation may inhibit the development of key nephrovascular toxins .


To date , quality intervention trials investigating this novel treatment in CKD are lacking .


The aim of SYNERGY is to assess the effectiveness of synbiotics ( co-administration of pre - and probiotics ) as a potential treatment targeting the synthesis of uremic toxins , specifically , indoxyl sulphate ( IS ) and p-cresyl sulphate ( PCS ) .


Thirty-seven patients with moderate to severe CKD ( Stage IV and V , pre-dialysis ) will be recruited to a double-blind , placebo-controlled , randomised cross-over trial .


Patients will be provided with synbiotic therapy or placebo for @ weeks , with a @week washout before cross-over .


The primary outcome is serum IS , total and free ( unbound ) concentrations , measured using ultra-performance liquid chromatography .


Secondary outcomes include serum PCS , total and free ( unbound ) concentrations ; cardiovascular risk , measured by serum lipopolysaccharides , serum trimethylamine-N-oxide ( TMAO ) and inflammation and oxidative stress markers ; kidney damage , measured by @hour proteinuria and albuminuria , estimated glomerular filtration rate and renal tubule damage ( urinary kidney injury molecule-@ ) ; patients ' self assessed quality of life ; and gastrointestinal symptoms .


In addition , the effects on the community structure of the stool microbiota will be explored in a subset of patients to validate the mechanistic rationale underpinning the synbiotic therapy .


IS and PCS are two novel uremic toxins implicated in both cardiovascular disease ( CVD ) and progression of CKD .


Preliminary studies indicate that synbiotic therapy maybe a promising strategy when considering a targeted , tolerable and cost-efficient therapy for lowering serum IS and PCS concentrations .


This trial will provide high quality ` proof-of-concept ' data to elucidate both the efficacy of synbiotic therapy for lowering the toxins and whether reductions in serum IS and PCS translate into clinical benefits .


Considering the potential of pre - and probiotics to not only shift toxin levels , but to also impede CVD and CKD progression , SYNERGY will provide vital insight into the effectiveness of this innocuous nutritional therapy .


Profound side-effects following intrathecal use of local anesthetics as the sole drugs of choice make spinal anesthesia for open appendicectomy uncommon .


The aim of this study was to evaluate the effectiveness of intra-operative analgesia produced by intrathecal tramadol and fentanyl during bupivacaine spinal anesthesia for open appendicectomy .


A prospective randomized study was performed .


A total of @ American Society of Anesthesiologists @ or @ patients scheduled for emergency open appendicectomy were analyzed .


Group FB ( n = @ ) received intrathecal fentanyl @ g plus @ ml of @ % hyperbaric bupivacaine , Group SB ( n = @ ) received @ ml normal saline plus @ ml of @ % hyperbaric bupivacaine and Group TB ( n = @ ) received intrathecal tramadol @ mg plus @ ml of @ % hyperbaric bupivacaine .


Visual analog scale scores and frequency of subjective symptoms among patients in the three groups formed the primary outcome measure of this study .


Effective intraoperative sensory block was achieved in @ % of patients in group FB and TB while @ ( @ % ) patients in group SB had ineffective sensory block ( P = @ ) .


The pain free period was significantly longer in patients in Group FB than Group SB and TB .


Mean time for Group FB with regard to first analgesic request was @ @ min , Group SB was @ @ and Group TB was @ @ min .


Incidence of complications were comparable among the three groups .


This study showed that intrathecal tramadol ( @ mg ) can safely replace intrathecal fentanyl ( @ g ) in the management of visceral pain and discomfort during subarachnoid block for appendicectomy .


Accumulation of visceral adipose tissue is associated with insulin resistance and cardio-vascular disease .


The aim of this study was to elucidate whether removal of a large amount of visceral fat by omentectomy in conjunction with Roux en-Y gastric bypass operation ( RYGB ) results in enhanced improvement of insulin sensitivity compared to gastric bypass surgery alone .


Eighty-one obese women scheduled for RYGB were included in the study .


They were randomized to RYGB or RYGB in conjunction with omentectomy .


Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp before operation and sixty-two women were also reexamined @ years post-operatively .


The primary outcome measure was insulin sensitivity and secondary outcome measures included cardio-metabolic risk factors .


Two-year weight loss was profound but unaffected by omentectomy .


Before intervention , there were no clinical or metabolic differences between the two groups .


The difference in primary outcome measure , insulin sensitivity , was not significant between the non-omentectomy ( @ mg/kg body weight/minute ) and omentectomy groups ( @ mg/kg body weight/minute ) after @ years .


Nor did any of the cardio-metabolic risk factors that were secondary outcome measures differ significantly .


Addition of omentectomy to gastric bypass operation does not give an incremental effect on long term insulin sensitivity or cardio-metabolic risk factors .


The clinical usefulness of omentectomy in addition to gastric bypass operation is highly questionable .


Convulsive Status Epilepticus ( CSE ) is a common neurological emergency with patients presenting with prolonged epileptic activity .


Sub-optimal management is coupled with high morbidity and mortality .


Continuous electroencephalogram ( EEG ) monitoring is considered essential by the National Institute for Health and Care Excellence ( NICE ) in the management of Convulsive Refractory Status Epilepticus ( CRSE ) .


The aim of this research was to determine current clinical practice in the management of CRSE amongst adults in intensive care units ( ICU ) in the UK and establish if the use of a standardised protocol requires re-enforcement within trusts .


@ randomly selected UK NHS Trusts were contacted and asked to complete a questionnaire in addition to providing their protocol for CRSE management in ICU .


@ ( @ % ) trusts responded .


While @ ( @ % of responders ) had a protocol available in ICU for early stages of CSE , just @ ( @ % ) trusts had specific guidelines if CRSE occurred .


Only @ ( @ % ) trusts involved neurologists at any stage of management and just @ ( @ % ) have access to continuous EEG monitoring .


This study identifies significant inconsistency in the management of CSE in ICU 's across the UK .


A minority of ICU units have a protocol for CRSE or access to continuous EEG monitoring despite it being considered fundamental for management and supported by NICE guidance .


Controlling hypertension rates and maintaining normal blood pressure , particularly in resource-constrained settings , represent ongoing challenges of effective and affordable implementation in health care .


One of the strategies being largely advocated to improve high blood pressure calls for salt reduction strategies .


This study aims to estimate the impact of a population-level intervention based on sodium reduction and potassium increase - in practice , introducing a low-sodium , high-potassium salt substitute - on adult blood pressure levels .


The proposed implementation research study includes two components : Phase @ , an exploratory component , and Phase @ , an intervention component .


The exploratory component involves a triangle taste test and a formative research study designed to gain an understanding of the best implementation methods .


Phase @ involves a pragmatic stepped wedge trial design where the intervention will be progressively implemented in several clusters starting the intervention randomly at different times .


In addition , we will evaluate the implementation strategy using a cost-effectiveness analysis .


This is the first project in a Latin-American setting to implement a salt substitution intervention at the population level to tackle high blood pressure .


Data generated and lessons learnt from this study will provide a strong platform to address potential interventions applicable to other similar low - and middle-income settings .


To investigate bladder and intestinal function recovery and quality of sexual life after laparoscopic nerve-sparing radical hysterectomy ( LNRH ) for treatment of early invasive cervical carcinoma .


Subjects included patients who underwent radical hysterectomy by laparotomy who were randomly assigned to @ groups : @ patients who underwent LNRH and @ classical laparoscopic radical hysterectomy ( LRH ) .


We assessed the patients general clinical information , surgical characteristics , pathological findings , and adjuvant therapies .


A urodynamic study was used to assess bladder function .


Intestinal function recovery and quality of sexual life were evaluated by questionnaire .


No significant differences were found in age , surgery characteristics , pathological findings , adjuvant therapies , and main adverse effects between the @ groups .


The mean duration of the postoperative catheterization ( DPC ) in group LNRH was shorter than that in group LRH ( P < @ ) .


The maximum flow rate , maximum cystometric capacity , maximum detrusor pressure and urinary complications in group LNRH were better than those in group LRH .


The quality of sexual life evaluated according to the female sexual function index ( FSFI ) was better in group LNRH than in those who underwent LRH .


The intestinal function of patients in group LNRH also recovered better compared with patients in group LRH .


Omega-@ fatty acids in free fatty acid form have enhanced bioavailability , and plasma levels are less influenced by food than for ethyl ester forms .


The aim was to evaluate the safety and lipid-altering efficacy in subjects with severe hypertriglyceridemia of an investigational pharmaceutical omega-@ free fatty acid ( OM@-FFA ) containing eicosapentaenoic acid and docosahexaenoic acid .


This was a multinational , double-blind , randomized , out-patient study .


Men and women with triglycerides ( TGs ) @ mg/dL , but < @ mg/dL , took control ( olive oil -LSB- OO -RSB- @ g/d ; n = @ ) , OM@-FFA @ g/d ( plus OO @ g/d ; n = @ ) , OM@-FFA @ g/d ( plus OO @ g/d ; n = @ ) , or OM@-FFA @ g/d ( n = @ ) capsules for @ weeks in combination with the National Cholesterol Education Program Therapeutic Lifestyle Changes diet .


Fasting serum TGs changed from baseline by -@ % ( P < @ vs OO ) , -@ % ( P < @ vs OO ) , and -@ % ( P < @ vs OO ) with @ , @ , and @ g/d OM@-FFA , respectively , compared with -@ % with OO .


Non-high-density lipoprotein cholesterol ( non-HDL-C ) , total cholesterol-to-HDL-C ratio , very low-density lipoprotein cholesterol , remnant-like particle cholesterol , apolipoprotein CIII , lipoprotein-associated phospholipase A@ , and arachidonic acid were significantly lowered ( P < @ at each OM@-FFA dosage vs OO ) ; and plasma eicosapentaenoic acid and docosahexaenoic acid were significantly elevated ( P < @ at each OM@-FFA dosage vs OO ) .


With OM@-FFA @ and @ g/d ( but not @ g/d ) , low-density lipoprotein cholesterol was significantly increased compared with OO ( P < @ vs OO ) .


High-sensitivity C-reactive protein responses with OM@-FFA did not differ significantly from the OO response at any dosage .


Fewer subjects reported any adverse event with OO vs OM@-FFA , but frequencies across dosage groups were similar .


Discontinuation due to adverse event , primarily gastrointestinal , ranged from @ % to @ % across OM@-FFA dosage groups vs @ % for OO .


OM@-FFA achieved the primary end point for TG lowering and secondary end point of non-HDL-C lowering at @ , @ , and @ g/d in persons with severe hypertriglyceridemia .


This trial was registered at www.clinicaltrials.gov as NCT@ .


High levels of emotional distress in cancer patients often goes unnoticed in daily clinical routine , resulting in severe undertreatment of mental health problems in this patient group .


Screening tools can be used to increase case identification , however , screening alone does not necessarily translate into better mental health for the patient .


Doctors play a key role in providing basic emotional support and transferring the patients in need of such specific support to mental health professionals .


This study investigates whether a stepped care model , combining screening , doctor consultation and professional psycho-oncological service in a structured way , improves the emotional wellbeing of cancer patients .


This study is a cluster randomized trial with two parallel groups ( intervention vs. care as usual ) , set in an academic hospital .


Participants are cancer patients , a total of @,@ at baseline .


The intervention consists of stepped psychosocial care .


Step one : screening for distress , step two : feedback of screening results to the doctor in charge of the patient and consultation with the patient , and step three : based on a shared patient-doctor decision , either transferal to the consultation liaison ( CL ) service or not .


The outcome will be emotional well-being half a year after baseline , ascertained with the Hospital Anxiety and Depression Scale .


Randomization will be done by the cluster randomization of wards .


Mental health problems not only cause emotional suffering but also direct and indirect costs .


This calls for timely and adequate psychosocial support , especially as we know that such support is effective .


However , not every cancer patient can and must be treated by a mental health professional .


Allocating limited resources most sensibly and economically is of crucial importance for our healthcare system to ensure the best quality of care to as many patients as possible .


It is the hope of the STEPPED CARE trial that this model is both effective and efficient , and that it can be implemented in other hospitals as well , if proven to be effective .


Low-dose clarithromycin has been recommended for the treatment of chronic rhinosinusitis without nasal polyps .


However , it is uncertain whether a high dose of clarithromycin is more effective than a low dose .


Forty-three chronic rhinosinusitis patients were randomised to low-dose or high-dose clarithromycin groups , and clinical efficacy was evaluated .


Pre - and post-treatment measures included : nasal symptom assessment , endoscopic inspection ( Lund-Kennedy system ) , a quality of life questionnaire ( the Sino-Nasal Outcome Test @ ) and examination of cytokine levels ( interleukin-@ and -@ ) in nasal secretions .


The high dose of clarithromycin was significantly better in terms of clinical efficacy than the low dose for the treatment of chronic rhinosinusitis ( p < @ ) .


Significant differences in nasal cytokine levels ( interleukin-@ and -@ ) were also observed between the low-dose and high-dose groups after short-term clarithromycin treatment ( p < @ ) .


Short-term , high-dose clarithromycin appears to be more effective for the treatment of chronic rhinosinusitis than low-dose clarithromycin .


Iron deficiency , associated with a decline in cognitive function , is the most common nutritional deficiency globally .


The present study aimed to identify the impact of weekly iron supplements on the attention function of female students from a high school in North Khorasan Province , Iran .


This was a blind , controlled , clinical trial study , involving @ female students who were chosen using the stratified randomised sampling method .


First , laboratory studies were performed to detect iron consumption limitations .


Next , the @ students were divided randomly and equally into case and control groups .


The case group was treated with @ mg of ferrous sulfate twice a week for @ weeks .


We compared both groups ' data on attention , iron status and erythrocyte indices .


Questionnaires were used to collect demographic data , while clinical data was collected using complete blood count and Toulouse-Piron tests .


Data was analysed using descriptive statistics , as well as paired and independent t-tests .


The mean attention scores of the case and control groups were @ @ and @ @ , respectively ( p < @ ) .


The mean haemoglobin levels of the two groups were @ @ and @ @ , respectively ( p < @ ) .


Compared to the control group , the attention scores and haemoglobin concentrations of the case group were found to be improved by approximately @ % and @ % , respectively .


Oral iron supplements ( @ mg twice a week for @ weeks ) were able to improve the attention span and haematologic indices of female high school students .


The aim of the present study was to evaluate the effect of applying electroencephalogram ( EEG ) biofeedback ( neurobiofeedback ) or electromyographic ( EMG ) biofeedback to conventional occupational therapy ( OT ) on improving hand function in stroke patients .


This study was designed as a preliminary clinical trial .


Thirty patients with stroke were entered the study .


Hand function was evaluated by Jebsen Hand Function Test pre and post intervention .


Patients were allocated to @ intervention cohorts : ( @ ) OT , ( @ ) OT plus EMG-biofeedback therapy , and ( @ ) OT plus neurofeedback therapy .


All patients received @ sessions of conventional OT .


Patients in cohorts @ and @ also received EMG-biofeedback and neurofeedback therapy , respectively .


EMG-biofeedback therapy was performed to strengthen the abductor pollicis brevis ( APB ) muscle .


Neurofeedback training was aimed at enhancing sensorimotor rhythm after mental motor imagery .


Hand function was improved significantly in the @ groups .


The spectral power density of the sensorimotor rhythm band in the neurofeedback group increased after mental motor imagery .


Maximum and mean contraction values of electrical activities of the APB muscle during voluntary contraction increased significantly after EMG-biofeedback training .


Patients in the neurofeedback and EMG-biofeedback groups showed hand improvement similar to conventional OT .


Further studies are suggested to assign the best protocol for neurofeedback and EMG-biofeedback therapy .


Prospective longitudinal study .


To explore the working mechanism of manual therapy , we investigated whether @ cervical spine variables were mediators of the effect of manual therapy on headache frequency .


Background Manual therapy has been shown to reduce headache frequency in participants with chronic tension-type headache ( CTTH ) .


To what extent specific elements of treatment contribute to the effectiveness of manual therapy in CTTH is unknown .


One hundred eighty-two participants with CTTH participated in a prospective longitudinal study : @ underwent manual therapy and @ participants received usual care by their general practitioner .


Regression analysis was performed according to the steps described by Baron and Kenny , and the proportion of mediated effect was estimated for @ potential mediators : ( @ ) cervical range of motion , ( @ ) neck flexor endurance , and ( @ ) forward head posture .


Outcome was defined as a @ % or greater reduction in headache days .


Neck flexor endurance mediated @ % of the effect of manual therapy .


Cervical range of motion and forward head posture showed no mediated effect .


Increased neck flexor endurance appears to be a working mechanism of manual therapy .


This finding supports isometric training of neck flexors in participants with CTTH .


Trial registered with Netherlands Trial Register ( TR @ ) .


ADHD is prevalent in adults and frequently associated with impairment and distress .


While medication is often the first line of treatment a high proportion of people with the condition are not fully treated by medication alone , can not tolerate medication or do not wish to take it .


Preliminary studies suggest that psychosocial approaches are a promising adjunctive or alternative treatment option .


To date , individual cognitive-behaviour therapy ( CBT ) has been found to be efficacious in three randomized controlled trials ( RCTs ) .


There is a need for more RCTs to be carried out in order to replicate these results in different sites , to further investigate the acceptability and feasibility of CBT in this population and to further develop CBT approaches based on a psychological model .


This randomized controlled trial investigates the efficacy of individual , formulation-based CBT when added to treatment-as-usual as compared with treatment as usual alone .


Sixty patients with a diagnosis of adult ADHD attending a specialist clinic are randomly allocated to @ of @ treatments , ` Treatment as Usual ' ( TAU ) or TAU plus @ sessions individual CBT ( TAU + CBT ) .


In the TAU + CBT , the first @ sessions take place over @ weeks with a @th ` follow-up ' session at @ weeks .


Outcomes are assessed at @ weeks and @ weeks following randomization .


The two primary outcomes are self-rated ADHD symptoms and functioning ( occupational and social ) .


Secondary outcomes include distress , mood , ADHD-related cognitions , ADHD-related behaviours and informant-rated ADHD symptoms .


The primary analysis will include all participants for whom data is available and will use longitudinal regression models to compare treatments .


Secondary outcomes will be analysed similarly .


The results of the study will provide information about a ) whether CBT adds benefit over and above TAU for ADHD and , b ) if CBT is found to be efficacious , potential mechanisms of change and predictors of efficacy .


Nebulisers aid the treatment of respiratory diseases , including asthma , but they require electricity and are often cost-prohibitive for low - and middle-income countries .


The aim of this study was to compare a low-cost , human-powered nebuliser compressor with an electric nebuliser compressor for the treatment of mild to moderate asthma exacerbations in adults and children .


This was a non-blinded , parallel-group , equivalence study , with @ subjects between @ and @ years of age , conducted in the emergency department of a district hospital in Ilopango , El Salvador .


Participants were assigned by random allocation to receive a @-mg dose of salbutamol from the experimental human-powered nebuliser or the electric nebuliser control .


All assigned participants completed treatment and were included in analysis .


The study was not blinded as this was clinically unfeasible ; however , data analysis was blinded .


The mean improvement in peak flow of the experimental and control groups was @ ( @ % confidence interval ( CI ) @-@ @ ) l/min and @ ( @ % CI , @-@ @ ) l/min , respectively , with a mean difference of @ ( @ % CI , -@ to @ ) l/min .


The mean improvement in percent-expected peak flow for the experimental and control groups was @ % ( @ % CI , @-@ @ % ) and @ % ( @ % CI , @-@ @ % ) , respectively , with a mean difference of @ % ( @ % CI , -@ to @ % ) .


The human-powered nebuliser compressor is equivalent to a standard nebuliser compressor for the treatment of mild-to-moderate asthma .


( Funded by the Opus Dean 's Fund , Marquette University College of Engineering ; ClinicalTrials.gov NCT@ . )


Idiopathic pulmonary fibrosis ( IPF ) is a chronic , devastating , interstitial lung disease , with few therapeutic options .


IPF is characterized by pulmonary restriction , dyspnea , hypoxemia , exercise intolerance and poor quality of life ( QOL ) .


We aimed to examine the effect of exercise training ( ET ) on clinical outcomes in IPF patients .


A randomized controlled study included thirty-two IPF patients ( aged @ @ years ) who were allocated either to the ET group ( n = @ ) , participating in a @-week , twice-weekly @-min supervised ET-based pulmonary rehabilitation program , or to a control group ( n = @ ) continuing with regular medical treatment alone .


Cardiopulmonary exercise test , @-min walking distance ( @MWD ) test , @-second chair-stand test , pulmonary function tests , dyspnea and QOL were assessed at baseline and at the end of the @-week intervention .


Significant differences were observed between the ET and the control groups in raw mean deltas ( = post - - pre-intervention ) : @MWD , @ m , p < @ ; VO@ peak , @ ml/kg/min , p = @ ; work rate , @ W , p < @ ; anaerobic threshold , @ ml/kg/min , p < @ , and FVC % predicted , @ % , p = @ .


Dyspnea , QOL and @-second chair-stand were also improved significantly following the program .


ET improves exercise tolerance , functional capacity , pulmonary function , dyspnea and QOL in patients with IPF , suggesting a short-term treatment efficacy for clinical improvement , and should be considered the standard care for IPF .


There is concern regarding the administration of iodinated contrast to patients with impaired renal function because of the increased risk of contrast-induced nephropathy .


Evaluate image quality and feasibility of a protocol with a reduced volume of iodinated contrast and utilization of dual-energy coronary CT angiography ( DECT ) vs a standard iodinated contrast volume coronary CT angiography protocol ( SCCTA ) .


A total of @ consecutive patients were randomized to SCCTA ( n = @ ) or DECT with rapid kVp switching ( n = @ ) .


Eighty milliliters and @ mL of iodinated contrast were administered in the SCCTA and DECT cohorts , respectively .


Two readers measured signal and noise in the coronary arteries ; signal-to-noise ratio ( SNR ) and contrast-to-noise ratio ( CNR ) were calculated .


A @-point signal/noise Likert scale was used to evaluate image quality ; scores of < @ were nondiagnostic .


Agreement was assessed through kappa analyses .


Demographics and radiation dose were not significantly different ; there was no difference in CNR between both cohorts ( P = @ ) .


A significant difference in SNR between the groups ( P = @ ) lost significance ( P = @ ) when adjusted for body mass index .


The median Likert score was inferior for DECT for reader @ ( @ @ vs @ @ ; P < @ ) but not reader @ ( @ @ vs @ @ ; P = @ ) .


Agreement in diagnostic interpretability in the DECT and SCCTA groups was @ % ( @ % confidence interval , @ % -@ % ) and @ % ( @ % confidence interval , @ % -@ % ) , respectively .


DECT resulted in inferior image quality scores but demonstrated comparable SNR , CNR , and rate of diagnostic interpretability without a radiation dose penalty while allowing for > @ % reduction in contrast volume compared with SCCTA .


Myostatin is a negative regulator of muscle growth .


Androgen deprivation ( ADT ) is associated with muscle loss and increased body fat , and currently available therapies have limited efficacy to treat this complication .


The antimyostatin peptibody ( AMG @/Mu-S ) markedly attenuated muscle loss and decreased fat accumulation in orchiectomized mice .


The objective of the study was to evaluate the safety , pharmacokinetics , and muscle efficacy of AMG @ in men undergoing ADT for nonmetastatic prostate cancer .


This was a randomized , blinded , placebo-controlled , multiple-dose , phase @ study of AMG @ given for @ days .


The end point of percentage change from baseline in lean body mass ( LBM ) as assessed by dual x-ray absorptiometry was prespecified .


Rates of adverse events ( AMG @ vs placebo ) were the following : diarrhea ( @ % vs @ % ) , fatigue ( @ % vs @ % ) , contusion ( @ % vs @ % ) , and injection site bruising ( @ % vs @ % ) .


Exposure increased linearly from @ mg/kg to @ mg/kg .


AMG @ significantly increased LBM in the @ mg/kg vs the placebo groups on day @ by @ % ( @ % SE , P = @ ) ; in exploratory fat mass analysis , a decrease of -@ % ( @ % SE , P = @ ) was observed .


Pharmacodynamic changes in muscle and fat were maintained at follow-up , @ month after day @ .


Four weekly s.c. doses of AMG @ were well tolerated and were associated with increased LBM and decreased fat in the men receiving ADT for nonmetastatic prostate cancer .


RESULTS support further investigation of AMG @ in clinical settings with muscle loss and atrophy .


To evaluate the efficacy of a single intravitreal injection of ocriplasmin @ g across relevant subpopulations of patients with symptomatic vitreomacular adhesion ( VMA ) / vitreomacular traction ( VMT ) , including when associated with macular hole .


Two multicenter , randomized , placebo-controlled , double-masked , @-month studies .


A total of @ randomized patients ( @ receiving ocriplasmin ; @ receiving placebo ) .


A single intravitreal injection of ocriplasmin @ g or placebo in the study eye .


Prespecified subgroup analyses were conducted to evaluate the effects on the proportion of patients with nonsurgical resolution of focal VMA at day @ , nonsurgical full-thickness macular hole ( FTMH ) closure at month @ , and categoric improvement in best-corrected visual acuity ( BCVA ) at month @ .


Resolution of VMA at day @ was achieved more often in younger patients ( < @ years ) , eyes without epiretinal membrane , eyes with FTMH , phakic eyes , and eyes with a focal VMA @ m. Eyes with FTMH width @ m were more likely to achieve nonsurgical FTMH closure .


Categoric @-line and @-line improvement in BCVA occurred more often in younger patients ( < @ years ) and in patients with a lower baseline BCVA ( < @ letters ) .


Treatment differences in favor of ocriplasmin were generally observed across each subgroup of subpopulations studied .


Subgroup analyses confirmed the positive effect of ocriplasmin across relevant subpopulations .


Unhealthy dietary behaviours are one of the key risk factors for many lifestyle-related diseases worldwide .


This randomised controlled trial aimed to increase the level of fruit , vegetable and fibre intake and decrease the fat and sugar consumption of mothers with young children ( @-@ years ) via the playgroup setting .


Playgroups located in @ neighbourhoods in Perth , Western Australia were randomly assigned to an intervention ( n = @ ) or control group ( n = @ ) .


Those in the intervention group received a @-month multi-strategy primarily home-based physical activity and nutrition program ( data is only presented on dietary behaviours ) .


Data on dietary consumption was collected via the Fat and Fibre Barometer and frequency of serves of fruit and vegetable and cups of soft drink , flavoured drink and fruit juice .


The effects of the intervention on continuous outcome measures were assessed using analysis of variance ( ANOVA ) , after adjusting for mother 's age and the corresponding variables .


The outcomes of the intervention were positive with the intervention group showing statistically significant improvements , when compared to the control group in the overall consumption of fat and fibre ( p < @ ) ; of fibre ( p < @ ) - fruit and vegetables ( p < @ ) , wholegrain ( p = @ ) : and fat ( p = @ ) - dairy products ( p = @ ) and lean meat and chicken ( p = @ ) .


There were no significant changes in the consumption of sweet drinks .


This intervention was successful in improving dietary intake in the intervention group participants .


The moderate positive outcomes indicate that playgroups potentially provide quite a viable setting to recruit , engage and retain this hard to reach group of mothers of young children in programs that support the adoption of health-enhancing behaviours .


This adds valuable information to this under researched area .


Noninvasive positive-pressure ventilation ( NPPV ) using intelligent volume-assured pressure support ( iVAPS ) combines volume - and pressure-preset NPPV and therefore uses a variation of inspiratory positive airway pressures .


The effect of iVAPS on sleep quality in stable hypercapnic patients with chronic obstructive pulmonary disease ( COPD ) has not been determined .


In this randomized , open-label , two-treatment , two-period , crossover study , patients were randomized to receive high-intensity ( HI ) - NPPV and then iVAPS or iVAPS and then HI-NPPV .


Patients were studied in hospital for @ consecutive nights , employing full polysomnography ( PSG ) , transcutaneous partial pressure of CO@ ( PtcCO@ ) monitoring , blood gas analysis and a visual analog scale ( VAS ) - based sleep questionnaire .


After discharge , patients used HI-NPPV and iVAPS at home , each for @ weeks .


They had to answer a VAS question concerning sleep every morning , and were telephoned weekly and asked additional questions .


At the end of each treatment period , they were visited at home for the determination of blood gases and treatment adherence , and to change the NPPV mode .


Fourteen patients were enrolled .


In-hospital PSG measurements showed no difference in sleep quality between iVAPS and HI-NPPV .


At home , patients reported more restful sleep during iVAPS than HI-NPPV ( p = @ ) .


Blood gases during spontaneous breathing at home did not differ with iVAPS and HI-NPPV , and there was a greater decrease in PtcCO@ during iVAPS than during HI-NPPV ( p = @ ) .


Although sleep quality in hospital was not different between iVAPS and HI-NPPV , COPD patients with chronic hypercapnic respiratory failure reported a trend towards more restful sleep at home with iVAPS .


In addition , nocturnal hypercapnia was effectively treated with iVAPS .


As the population ages , the relative and absolute number of age-associated diseases such as dementia will increase .


Evaluation of the suitability and intake of medication and pharmacological treatment is an important aspect of care for people with dementia , especially if they live at home .


Regular medication reviews and systematic cooperation between physicians and pharmacists are not common in routine care .


Medication management ( MM ) , based on such a comprehensive home medication review could help to reduce drug-related problems and costs .


The present article presents a medication management specifically for the application in the ambulatory setting and describes its implementation as part of a larger trial .


A home medication review ( HMR ) and MM is implemented as part of the DelpHi study , a population based prospective , cluster-randomized controlled intervention study to test the efficacy and efficiency of the implementation of a collaborative care model in primary care .


people with dementia ( PWD ) and their caregivers are recruited by the patient 's general practitioner .


Inclusion criteria are a positive screening result for dementia , living at home and regular intake of drugs .


PWD are asked to specify their regular pharmacy which is asked to participate in the study , too .


a comprehensive HMR is conducted as computer-assisted personal interview by specifically qualified Dementia Care Manager ( DCM ) at the people 's home .


It includes detailed information about drugs taken , their storage , administration , adherence and adverse events .


The MM is conducted in cooperation between DCM , pharmacist and general practitioner and consists of a pharmaceutical evaluation , pharmaceutical recommendations and their application .


Pharmacists are trained and provided with regularly updated information .


The MM is designed to give information and recommendations concerning antidementia drugs , occurrence of drug related problems , intake of anticholinergic drugs , potentially clinically relevant drug-drug-interactions , adverse drug events and medication adherence .


The DelpHi-approach for medication management employs comprehensive instruments and procedures in the primary care setting under routine care conditions , and this approach should be useful in improving pharmacotherapy as part of the comprehensive treatment and care for people with dementia .


Currently , there are over @ smoking cessation smartphone apps available , downloaded an estimated @,@ times per month .


No prior studies have examined how individuals engage with specific features of cessation apps and whether use of these features is associated with quitting .


Using data from a pilot trial of a novel smoking cessation app , we examined : ( i ) the @ most-used app features , and ( ii ) prospective associations between feature usage and quitting .


Participants ( n = @ ) were from the experimental arm of a randomized , controlled pilot trial of an app for smoking cessation called `` SmartQuit , '' which includes elements of both Acceptance and Commitment Therapy ( ACT ) and traditional cognitive behavioral therapy ( CBT ) .


Utilization data were automatically tracked during the @-week treatment phase .


Thirty-day point prevalence smoking abstinence was assessed at @-day follow-up .


The most-used features - quit plan , tracking , progress , and sharing - were mostly CBT .


Only two of the @ most-used features were prospectively associated with quitting : viewing the quit plan ( p = @ ) and tracking practice of letting urges pass ( p = @ ) .


Tracking ACT skill practice was used by fewer participants ( n = @ ) but was associated with cessation ( p = @ ) .


In this exploratory analysis without control for multiple comparisons , viewing a quit plan ( CBT ) as well as tracking practice of letting urges pass ( ACT ) were both appealing to app users and associated with successful quitting .


Aside from these features , there was little overlap between a feature 's popularity and its prospective association with quitting .


Tests of causal associations between feature usage and smoking cessation are now needed .


This multicenter , phase @ trial evaluated oral lubiprostone for constipation associated with non-methadone opioids in patients with chronic noncancer-related pain .


Adults with opioid-induced constipation ( OIC ; < @ spontaneous bowel movements -LSB- SBMs -RSB- per week ) were randomized @:@ to double-blind lubiprostone @g or placebo twice daily for @ weeks .


The primary end point was the overall SBM response rate .


Responders had at least moderate response ( @ SBM improvement over baseline frequency ) in all treatment weeks with available observed data , as well as full response ( @ SBMs per week ) for at least @ of the @ treatment weeks .


In total , @ patients were randomized ; @ each received lubiprostone and placebo , and @ were not treated .


Overall , the SBM response rate was significantly higher for patients treated with lubiprostone vs. placebo ( @ vs. @ % , respectively ; P = @ ) .


Overall mean change from baseline in SBM frequency was significantly greater with lubiprostone vs. placebo ( @ vs. @ , respectively ; P = @ ) .


The median time to first SBM was significantly shorter with lubiprostone vs. placebo ( @ vs. @ h , respectively ; P = @ ) .


Compared with placebo , the patients treated with lubiprostone exhibited significant improvements in straining ( P = @ ) , stool consistency ( P < @ ) , and constipation severity ( P = @ ) .


No significant differences were observed in quality-of-life measures or the use of rescue medication ; however , the percentage of patients who used rescue medication was consistently lower in the lubiprostone group than in the placebo group at months @ ( @ vs. @ % ) , @ ( @ vs. @ % ) , and @ ( @ vs. @ % ) .


Adverse events ( AEs ) > @ % were diarrhea , nausea , vomiting , and abdominal pain ( lubiprostone : @ , @ , @ , and @ % , respectively ; placebo , @ , @ , @ , and @ % , respectively ) .


None of the serious AEs ( lubiprostone , @ % ; placebo , @ % ) were related to lubiprostone .


Lubiprostone significantly improved symptoms of OIC and was well tolerated in patients with chronic noncancer pain .


Strength training and neuromuscular electrical stimulation ( NMES ) improve lower-limb muscle function in dyspnoeic individuals with chronic obstructive pulmonary disease ( COPD ) .


However , high-frequency NMES ( HF-NMES ) and strength training have never been compared head-to-head ; and effects of low-frequency NMES ( LF-NMES ) have never been studied in COPD .


Therefore , the optimal training modality to improve lower-limb muscle function , exercise performance and other patient-related outcomes in individuals with severe COPD remains unknown .


To study prospectively the efficacy of HF-NMES ( @Hz ) , LF-NMES ( @Hz ) or strength training in severely dyspnoeic individuals with COPD with quadriceps muscle weakness at baseline .


@ individuals with COPD ( FEV@ : @ % predicted , men : @ % , age : @ years ) were randomised to HF-NMES , LF-NMES or strength training as part of a comprehensive inpatient pulmonary rehabilitation programme .


No treadmill walking or stationary cycling was provided .


Groups were comparable at baseline .


Quadriceps muscle strength increased after HF-NMES ( +@ Newton-metre ( Nm ) ) or strength training ( +@ Nm ; both p < @ ) , but not after LF-NMES ( +@ Nm ; p = @ ) .


Quadriceps muscle endurance , exercise performance , lower-limb fat-free mass , exercise-induced symptoms of dyspnoea and fatigue improved significantly compared with baseline after HF-NMES , LF-NMES or strength training .


The increase in quadriceps muscle strength and muscle endurance was greater after HF-NMES than after LF-NMES .


HF-NMES is equally effective as strength training in severely dyspnoeic individuals with COPD and muscle weakness in strengthening the quadriceps muscles and thus may be a good alternative in this particular group of patients .


HF-NMES , LF-NMES and strength training were effective in improving exercise performance in severely dyspnoeic individuals with COPD and quadriceps weakness .


Ready-to-use therapeutic foods ( RUTF ) are lipid-based pastes widely used in the treatment of acute malnutrition .


Current specifications for RUTF permit a high n-@ polyunsaturated fatty acid ( PUFA ) content and low n-@ PUFA , with no stipulated requirements for preformed long-chain n-@ PUFA .


The objective of this study was to develop an RUTF with elevated short-chain n-@ PUFA and measure its impact , with and without fish oil supplementation , on children 's PUFA status during treatment of severe acute malnutrition .


This randomized controlled trial in children with severe acute malnutrition in rural Kenya included @ children aged @ to @ months who were randomized to receive i ) RUTF with standard composition ; ii ) RUTF with elevated short chain n-@ PUFA ; or iii ) RUTF with elevated short chain n-@ PUFA plus fish oil capsules .


Participants were followed-up for @ months .


The primary outcome was erythrocyte PUFA composition .


Erythrocyte docosahexaenoic acid ( DHA ) content declined from baseline in the two arms not receiving fish oil .


Erythrocyte long-chain n-@ PUFA content following treatment was significantly higher for participants in the arm receiving fish oil than for those in the arms receiving RUTF with elevated short chain n-@ PUFA or standard RUTF alone : @ months after enrollment , DHA content was @ % ( interquartile range @-@ @ ) , @ % ( @-@ @ ) , and @ % ( @-@ @ ) of total erythrocyte fatty acids ( P < @ ) , respectively , while eicosapentaenoic acid ( EPA ) content was @ % ( @-@ @ ) , @ % ( @-@ @ ) , and @ % ( @-@ @ ) ( P < @ ) .


RUTF with elevated short chain n-@ PUFA and fish oil capsules were acceptable to participants and carers , and there were no significant differences in safety outcomes .


PUFA requirements of children with SAM are not met by current formulations of RUTF , or by an RUTF with elevated short-chain n-@ PUFA without additional preformed long-chain n-@ PUFA .


Clinical and growth implications of revised formulations need to be addressed in large clinical trials .


Recent studies have reported beneficial effects of probiotics on maternal glycemia in healthy pregnant women .


Obesity significantly increases risk of impaired glucose tolerance in pregnancy , but glycemic effects of probiotics in this specific obstetric group require additional investigation .


The aim of the Probiotics in Pregnancy Study was to investigate the effect of a probiotic capsule on maternal fasting glucose in obese pregnant women .


In this placebo-controlled , double-blind , randomized trial , @ pregnant women with an early pregnancy body mass index ( BMI ; in kg/m ) from @ to @ were recruited from antenatal clinics at the National Maternity Hospital , Dublin , Ireland .


Exclusion criteria were BMI < @ or > @ , prepregnancy or gestational diabetes , age < @ y , multiple pregnancy , and fetal anomaly .


Women were randomly assigned to receive either a daily probiotic or a placebo capsule from @ to @ wk of gestation in addition to routine antenatal care .


The primary outcome was the change in fasting glucose between groups from preintervention to postintervention .


Secondary outcomes were the incidence of gestational diabetes and neonatal anthropometric measures .


In @ women who completed the study ( @ women in the probiotic group ; @ women in the placebo group ) , mean ( SD ) early pregnancy BMI was @ @ , which differed significantly between probiotic ( @ @ ) and placebo ( @ @ ) groups .


With adjustment for BMI , the change in maternal fasting glucose did not differ significantly between treated and control groups -LSB- -@ @ compared with -@ @ mmol/L ; P = @ ; B = -@ ( @ % CI : -@ , @ ) -RSB- .


There were also no differences in the incidence of impaired glycemia ( @ % in the probiotic group compared with @ % in the placebo group ; P = @ ) , birth weight ( @ kg in the probiotic group compared with @ kg in the placebo group ; P = @ ) , or other metabolic variables or pregnancy outcomes .


A secondary analysis of @ women , excluding antibiotic users and poor compliers , also revealed no differences in maternal glucose or other outcomes between groups .


Probiotic treatment of @ wk during pregnancy did not influence maternal fasting glucose , the metabolic profile , or pregnancy outcomes in obese women .


Employment has been identified as an important part of substance abuse treatment and is a predictor of treatment retention , treatment completion , and decreased relapse .


Although employment interventions have been designed for substance abusers , few interventions have focused specifically on drug-involved offenders .


The purpose of this study was to examine employment outcomes for drug-involved offenders who received a tailored employment intervention .


In a randomized controlled trial , baseline and follow-up data were collected from @ drug-involved offenders who were enrolled in a drug court program .


Participants were randomly assigned to drug court as usual ( control group ) or to the employment intervention in addition to drug court .


Intent-to-treat analyses found that the tailored intervention was associated only with more days of paid employment at follow-up ( @ vs. @ days ) .


When focusing on those with greater employment assistance needs , a work trajectory analyses , which took into account participants ' pre-baseline employment pattern ( negative or positive ) , revealed that intervention group participants had higher rates of employment ( @ % vs. @ % ) , more days paid for employment ( @ vs. @ days ) , and more employment income ( $ @ vs. $ @ ) at follow-up than control group participants .


The present study adds to the growing substance abuse and employment literature .


It demonstrates the efficacy of an innovative employment intervention tailored for drug-involved offenders by showing positive changes in @-month employment outcomes , most strongly for those who have not had recent employment success .


Reported response rates of transitional cell carcinoma ( TCC ) in dogs to piroxicam in combination with either mitoxantrone or carboplatin are similar ; however , it is unknown whether either drug might provide superior duration of response .


To determine if the progression-free interval ( PFI ) of dogs with TCC treated with mitoxantrone and piroxicam was different than that of dogs receiving carboplatin and piroxicam .


The hypothesis was that the efficacy of mitoxantrone is no different from carboplatin .


Fifty dogs with TCC without azotemia .


Prospective open-label phase III randomized study .


Either mitoxantrone or carboplatin was administered every @ weeks concurrently with piroxicam with restaging at @-week intervals .


Twenty-four dogs received carboplatin and @ received mitoxantrone .


Response was not different between groups ( P = @ ) .


None of the dogs showed complete response .


In the mitoxantrone group , there were @ ( @ % ) partial responses ( PR ) and @ ( @ % ) dogs with stable disease ( SD ) .


In the carboplatin group , there were @ PR ( @ % ) and @ ( @ % ) dogs with SD .


The PFI was not significantly different between groups ( mitoxantrone = @ days ; carboplatin = @ days ; P = @ ; hazard ratio @ ; @ % confidence interval @-@ @ ) .


Dogs with prostatic involvement experienced a shorter survival ( median , @ days ) compared to dogs with urethral , trigonal , or apically located tumors ; this difference was significant ( median @ , @ , and @ days , respectively ; P = @ ) .


This study did not detect a different in outcome in dogs with TCC treated with either mitoxantrone or carboplatin in combination with piroxicam .


Computerized decision support systems ( CDSSs ) are increasingly used to improve quality of care .


There is evidence for moderate to large effects from randomized controlled trials ( RCTs ) , but evidence on their effectiveness when implemented at a national level is lacking .


In the Netherlands , the Dutch College of General Practitioners ( NHG ) initiated their successful guideline program already @years ago .


NHGDoc , a CDSS based on these NHG guidelines , covering multiple disease areas for general practice , was developed in @ with the aim to improve quality of primary care .


In this paper , a protocol is presented to evaluate the uptake and effects of NHGDoc .


A cluster RCT will be conducted among @ general practices in the Netherlands .


Eligible general practices will be randomized to receive either the regular NHGDoc decision support modules ( control arm ) or the regular modules plus an additional module on heart failure ( intervention arm ) .


The heart failure module consists of patient-specific alerts concerning the treatment of patients with heart failure .


The effect evaluation will focus on performance indicators ( e.g. , prescription behavior ) as well as on patient outcomes ( e.g. , hospital admissions ) relevant in the domain of heart failure .


Additionally , a process evaluation will be conducted to gain insight into the barriers and facilitators that affect the uptake and impact of NHGDoc .


Results of this study will provide insight in the uptake and impact of a multiple-domain covering CDSS for primary care implemented by a national guideline organization to improve the quality of primary care .


Whereas the trial focuses on a specific domain of care-heart failure-conclusions of this study will shed light on the functioning of CDSSs covering multiple disease areas for primary care , particularly as this study also explores the factors contributing to the system 's uptake and effectiveness .


The purpose of this study was to compare the utility of @ surgical models for obstetric anal sphincter repair for improving resident knowledge , confidence level , and repair technique .


Third - and fourth-year obstetrics and gynecology residents at LAC + USC Medical Center performed simulated anal sphincter repair on both sponge and beef tongue surgical models .


Resident knowledge , confidence , technical skill , and preference were assessed after each model was performed .


Both models significantly improved resident confidence ( sponge , P = @ ; tongue , P = @ ) and knowledge ( @ % correct before intervention vs. @ % correct after intervention , P < @ ) .


There was no difference detected between the @ models .


All participants preferred the tongue model to the sponge model .


When performing both models , performing the tongue model after the sponge model resulted in a further increase in confidence ( P = @ ) CONCLUSIONS : Both models are excellent tools to aid in resident teaching of obstetric anal sphincter repair and significantly increase residents ' knowledge and confidence .


The purpose of this study was to determine whether the SPRINT definition of a `` critical-sized defect '' ( fracture gap at least @ cm in length and involving over @ % of the cortical diameter ) was accurate , to discern which factors predict reoperation in patients with these defects , and to compare the patient-based outcomes of these patients with patients without a critical defect .


Therapeutic Cohort Study .


Level @ and level @ trauma centers .


Thirty-seven patients in the SPRINT trial with a critical-sized defect participated .


We evaluated these patients for planned and unplanned secondary intervention to gain union .


Additionally , we evaluated which other factors predicted the need for reoperation .


Finally , the @ patients with a critical defect were compared with the larger cohort of patients without a defect with respect to demographics , mechanism of injury , fracture characteristics , and patient-based outcome .


Revision surgery for tibial nonunion .


Of the @ patients with a large fracture gap , @ patients had a planned secondary procedure .


Of the remaining @ patients in whom the attending surgeon adopted a `` watch and wait '' strategy , @ patients ( @ % ) never required additional surgery to gain union .


Additional surgery to gain union was less likely in patients treated with a reamed nail ( P = @ ) and in female patients ( P = @ ) .


Patients with a critical-sized defect were more likely to have a high-energy mechanism of injury ( P = @ ) , AO-OTA fracture type @ B or C ( P < @ ) , and location involving the middle third of the tibia ( P = @ ) .


The @-month SF-@ physical component summary score in patients with a critical-sized defect was @ @ ( mean SD ) compared with @ @ in those without a critical defect ( P = @ , difference = @ , @ % confidence interval = @-@ @ ) .


Tibial diaphyseal defects of > @ cm and > @ % cortical circumference healed without additional surgery in @ % of cases .


This definition of a critical-sized defect is not `` critical . ''


However , as compared with the overall cohort of tibial fractures , patients with these bone defects had a higher rate of reoperation and worse patient-based outcomes .


Further investigation is required to determine which factors predict union in this challenging fracture to avoid unnecessary secondary surgery .


Prognostic level I. See instructions for authors for a complete description of levels of evidence .


Overweight and obesity are associated with an increased risk of morbidity .


Mindfulness training could be an effective strategy to optimize lifestyle behaviors related to body weight gain .


The aim of this study was to evaluate the effectiveness of a worksite mindfulness-based multi-component intervention on vigorous physical activity in leisure time , sedentary behavior at work , fruit intake and determinants of these behaviors .


The control group received information on existing lifestyle behavior - related facilities that were already available at the worksite .


In a randomized controlled trial design ( n = @ ) , @ workers received a mindfulness training , followed by e-coaching , lunch walking routes and fruit .


Outcome measures were assessed at baseline and after @ and @ months using questionnaires .


Physical activity was also measured using accelerometers .


Effects were analyzed using linear mixed effect models according to the intention-to-treat principle .


Linear regression models ( complete case analyses ) were used as sensitivity analyses .