bluuebunny/crossref_metadata_2025 huggingface dataset:
Determining acute nurse staffing: a hermeneutic review of an evolving science
Authors: Leary Alison , Punshon Geoffrey
Published: March 2019

Background

Calculating nurse staffing in the acute hospital has become a key issue but solutions appear distant. Community, mental health and areas such as learning disability nursing have attracted less attention and remain intractable. This review aims to examine current approaches to the issue across many disciplines.

Design

The approach taken is iterative and in the form of a hermeneutic review. 769 pieces of evidence were reviewed from across disciplines such as nursing, medicine, engineering, statistics, population science, computer science and mathematics where hospital nurse staffing was the subject of the study.

Results

A number of themes emerged. The first iteration showed the predominance of unit base approaches (eg, nurse numbers, ratios, activity and workload) and the second was the development of methodologies. Subsequent iterations examined issues such as demand, safety, nurse education, turnover, patient outcomes, patient or staff satisfaction, workload and activity. The majority of studies examined (n=767) demonstrated some association between staffing (units or type/skill) and various factors such as staff or patient satisfaction, working conditions, safety parameters, outcomes complexity of work achieved, work left undone or other factors. Many potential areas such as operational safety research were not utilised.

Conclusion

Although the relationship between staffing in acute care and factors such as units, safety or workload is complex, the evidence suggests an interdependent relationship which should only be dismissed with caution. The nature of these relationships should be further examined in order to determine nurse staffing. The body of knowledge appears substantial and complex yet appears to have little impact on policy.
Socioeconomic inequalities in obesity: modelling future trends in Australia
Authors: Hayes Alison , Tan Eng Joo , Killedar Anagha , Lung Thomas
Published: March 2019

Objectives

To develop a model to predict future socioeconomic inequalities in body mass index (BMI) and obesity.

Design

Microsimulation modelling using BMI data from adult participants of Australian Health Surveys, and published data on the relative risk of mortality in relation to BMI and socioeconomic position (SEP), based on education.

Setting

Australia.

Participants

74 329 adults, aged 20 and over from Australian Health Surveys, 1995–2015.

Primary and secondary outcome measures

The primary outcomes were BMI trajectories and obesity prevalence by SEP for four birth cohorts, born 10 years apart, centred on 1940, 1950, 1960 and 1970.

Results

Simulations projected persistent or widening socioeconomic inequality in BMI and obesity over the adult life course, for all birth cohorts. Recent birth cohorts were predicted to have greater socioeconomic inequality by middle age, compared with earlier cohorts. For example, among men, there was no inequality in obesity prevalence at age 60 for the 1940 birth cohort (low SEP 25% (95% CI 17% to 34%); high SEP 26% (95% CI 19% to 34%)), yet for the 1970 birth cohort, obesity prevalence was projected to be 51% (95% CI 43% to 58%) and 41% (95% CI 36% to 46%) for the low and high SEP groups, respectively. Notably, for more recent birth cohorts, the model predicted the greatest socioeconomic inequality in severe obesity (BMI >35 kg/m2) at age 60.

Conclusions

Lower SEP groups and more recent birth cohorts are at higher risk of obesity and severe obesity, and its consequences in middle age. Prevention efforts should focus on these vulnerable population groups in order to avoid future disparities in health outcomes. The model provides a framework for further research to investigate which interventions will be most effective in narrowing the gap in socioeconomic disparities in obesity in adulthood.
Effect of lateral positioning on the bronchial cuff pressure of a left-sided double-lumen endotracheal tube during thoracic surgery: study protocol for a prospective observational study
Authors: Kim Eugene , Kim In-Young , Byun Sung-Hye
Published: March 2019

Introduction

Correct pressure is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. An inadequate bronchial cuff pressure (BCP) can cause air leak and interfere with visualisation of the surgical field, whereas an excessive pressure BCP can lead to cuff-related complications. Based on several reports that cuff pressure could alter after a positional change when using an endotracheal tube, we hypothesise that a change from the supine position to the lateral decubitus position, which is essential for thoracic surgery, would affect the BCP of the DLT.

Methods and analysis

This prospective, single-centre, observational study will enrol 74 patients aged 18–70 years undergoing elective lung surgery from September 2018 to April 2019. The primary outcome will be the change in the ‘initially established BCP’ (maximum BCP not exceeding 40 cm H2O with no air leak in the supine position) after lateral decubitus positioning. BCP and air leak will be assessed in each patient position during inflation of the cuff with air in 0.5 mL increments from 0 to 3 mL. Secondary outcomes will include the incidence of BCP exceeding 40 cm H2O after the initial established value and that of a change in the smallest bronchial cuff volume without air leak after a change to the lateral position. The relationship between the change in BCP and airway pressure, compliance and body mass index after lateral positioning will be investigated.

Ethics and dissemination

The study will be conducted in accordance with the Declaration of Helsinki and supervised by the Daegu Catholic University Medical Center institutional review board (study approval number CR-18–111). All patients will receive information about the study and will need to provide written informed consent before enrolment. The results will be presented at an international meeting and published in a peer-reviewed journal.

Trial registration number

NCT03656406; Pre-results.
Dose–response association between physical activity and non-alcoholic fatty liver disease: a case–control study in a Chinese population
Authors: Li YangFan , He Fei , He Yun , Pan XinTing , Wu YunLi , Hu ZhiJian , Lin Xu , Peng Xian-E , Xu ShangHua
Published: March 2019

Aim

Physical activity plays an important role in the development of non-alcoholic fatty liver disease (NAFLD).However, the optimal intensity and dose of physical activity for the treatment of NAFLD have yet to be found. In the present study, we aimed to provide a dose–response association between physical activity and NAFLD in a Chinese population.

Methods

We recruited 543 patients with NAFLD diagnosed by abdominal ultrasonography, and 543 age-matched and sex-matched controls. The amount of physical activity, sedentary time and energy intake was collected through a structured questionnaire. Logistic regression analyses were performed to investigate the association between physical activity and NAFLD.

Results

After adjusting for hypertension, diabetes, body mass index, fasting blood glucose, energy intake and sedentary time, the total amount of physical activity was found to be inversely associated with NAFLD in a dose-dependent manner in men (>3180 metabolic equivalent of energy [MET]-min/week vs ≤1440 MET-min/week: OR 0.60, 95% CI 0.40 to 0.91, p for trend=0.01). In addition, both moderate-intensity and vigorous-intensity physical activity were effective in reducing the risk of NAFLD, independent of confounding variables in men (moderate-intensity physical activity: >684 MET-min/week vs none: OR 0.58, 95% CI 0.40 to 0.86, p for trend=0.01; vigorous-intensity physical activity: >960 MET-min/week vs none: OR 0.63, 95% CI 0.41 to 0.95, p for trend=0.02).

Conclusions

Physical activity was inversely associated with risk of NAFLD in a dose-dependent manner in men. Vigorous-intensity and moderate-intensity physical activity were both beneficial to NAFLD, independent of sedentary time and energy intake.
Home-based Anti-Tuberculosis Treatment Adverse Reactions (HATTAR) study: a protocol for a prospective observational study
Authors: Yang Miaomiao , Pan Hongqiu , Lu Lihuan , He Xiaomin , Chen Hongbo , Tao Bilin , Liu Wenpei , Yi Honggang , Tang Shaowen
Published: March 2019

Introduction

Tuberculosis (TB) continues to be an important public health problem throughout much of the world. Drug treatment is the only effective treatment method, but adverse drug events (ADEs) and adverse drug reactions (ADRs) can affect medication adherence. As the number of drug-resistant TB patients and the number of anti-TB drugs have increased, it is necessary to explore the risk factors for ADEs/ADRs to reduce their occurrence. This study aims to build a home-based anti-TB treatment cohort and to recognise the incidences, prognosis and risk factors of anti-TB drug-induced ADEs/ADRs in real-world experiences.

Methods and analysis

This study is a multicentre, prospective observational cohort study. The study population will consist of 3200 newly diagnosed TB patients between January 2019 and December 2020. After initiating the anti-TB treatment, all patients will be followed up until finishing treatment unless they withdraw, and we will record personal drug use and signs and/or symptoms of discomfort. Patients will receive scheduled laboratory tests in designated hospitals every 2 weeks during the first 2 months, and the residual blood sample after conducting the laboratory tests will be preserved. The ADEs/ADRs will be placed into eight categories: liver dysfunction, gastrointestinal reactions, drug allergy, arthralgia or muscle pain, nervous system disorders, haematological system disorders, renal impairment and others.

Ethics and dissemination

This study protocol has been approved by the ethics committees of Nanjing Medical University. All patients will give written informed consent before enrollment. The findings of the study will be published in peer-reviewed journals and will be presented at national and international conferences.
Impact of using patient-reported outcome measures in routine clinical care of paediatric patients with chronic conditions: a systematic review protocol
Authors: Bele Sumedh , Mohamed Bijan , Chugh Ashton , Haverman Lotte , Santana Maria-Jose
Published: March 2019

Introduction

Chronic diseases among children are associated with lower health-related quality of life (HRQOL) and higher utilisation of healthcare services. Integrating Patient-Reported Outcomes Measures (PROMs) in routine clinical care has been shown to reduce utilisation of healthcare services while improving patient outcomes. The objectives of our study are to: (1) identify previously implemented and evaluated PROMs for chronic conditions in paediatric settings; (2) consolidate the evidence to evaluate the impact of using PROMs on HRQOL, healthcare utilisation, patient outcomes (eg, symptoms control) and quality of care among paediatric patients with chronic conditions. The findings from this review will inform the future integration of PROMs in paediatric clinical practice.

Methods and analysis

We will systematically search the following electronic databases: MEDLINE, EMBASE, CINAHL, PsychINFO and Cochrane library. Reference lists of included studies will also be searched in Web of Science (Thomson Reuters) database to ensure more complete coverage. Two reviewers will independently screen the studies and abstract the data using standardised form. Extracted data will be analysed and synthesised. Finally, a narrative synthesis of summarised data will be presented.

Ethics and dissemination

Ethical approval is not required, as the proposed systematic review will use data from published research articles. The results of this study will be disseminated through publication in peer-reviewed journals, scientific conferences and meetings, and the lead author’s doctoral dissertation.

PROSPERO registration number

CRD42018109035.
The impact of different prostate-specific antigen (PSA) testing intervals on Gleason score at diagnosis and the risk of experiencing false-positive biopsy recommendations: a population-based cohort study
Authors: Palsdottir Thorgerdur , Nordstrom Tobias , Karlsson Andreas , Grönberg Henrik , Clements Mark , Eklund Martin
Published: March 2019

Objective

Given a man’s current prostate- specific antigen (PSA) level, age and family history of prostate cancer, what are the benefits (decreased risk of higher Gleason score [GS] cancer at diagnosis) and harms (increased risk of false-positive biopsy recommendation) of waiting 1, 2, 3, 4 or 5–8 years until the next PSA test?

Design

Prospective cohort.

Setting

All PSA tested men in Stockholm, Sweden, between 2003 and 2015.

Participants

Men aged 50–74 years with at least two PSA tests between 2003 and 2015 (n=174 636).

Main outcome measures

Log-binomial regression to calculate the risk ratio (RR) of GS ≥7 and GS 6 versus benign outcome at prostate biopsy and 12-year cumulative probability of experiencing a false-positive biopsy by testing interval, age, PSA level and first-degree family history.

Results

Men with PSA ≤1 ng/mL had low risk of GS ≥7 prostate cancer irrespective of testing interval; <3% had a PSA >3 at the next testing occasion, and of the 663 men biopsied after the next PSA test only 32 (5%) had GS ≥7 cancer. Men with PSA >1 ng/mL had increased risk of being diagnosed with GS ≥7 prostate cancer when screened with longer than annual intervals (RRs ranged from 1.4 to 3.2 depending on PSA level and testing interval). The results were consistent across age groups and family history status. This benefit needs to be balanced against the increased risk for false-positive biopsy recommendation with shorter testing intervals (twofold for annual vs biennial and threefold for annual vs triennial).

Conclusions

Men aged 50–74 years with PSA ≤1 ng/mL can wait 3–4 years before having a new PSA test. For men with PSA >1 ng/mL, we observed an increased risk of being diagnosed with GS ≥7 prostate cancer with longer than annual testing intervals. This benefit needs to be balanced against the markedly increased risks for false-positive biopsy recommendations with shorter testing intervals recommendations.
Protocol for a mixed methods realist evaluation of regional District Health Board groupings in New Zealand
Authors: Stokes Tim , Atmore Carol , Penno Erin , Richard Lauralie , Wyeth Emma , Richards Rosalina , Doolan-Noble Fiona , Gray Andrew R , Sullivan Trudy , Gauld Robin
Published: March 2019

Introduction

Achieving effective integration of healthcare across primary, secondary and tertiary care is a key goal of the New Zealand (NZ) Health Strategy. NZ’s regional District Health Board (DHB) groupings are fundamental to delivering integration, bringing the country’s 20 DHBs together into four groups to collaboratively plan, fund and deliver health services within their defined geographical regions. This research aims to examine how, for whom and in what circumstances the regional DHB groupings work to improve health service integration, healthcare quality, health outcomes and health equity, particularly for Māori and Pacific peoples.

Methods and analysis

This research uses a mixed methods realist evaluation design. It comprises three linked studies: (1) formulating initial programme theory (IPT) through developing programme logic models to describe regional DHB working; (2) empirically testing IPT through both a qualitative process evaluation of regional DHB working using a case study design; and (3) a quantitative analysis of the impact that DHB regional groupings may have on service integration, health outcomes, health equity and costs. The findings of these three studies will allow refinement of the IPT and should lead to a programme theory which will explain how, for whom and in what circumstances regional DHB groupings improve service integration, health outcomes and health equity in NZ.

Ethics and dissemination

The University of Otago Human Ethics Committee has approved this study. The embedding of a clinician researcher within a participating regional DHB grouping has facilitated research coproduction, the research has been jointly conceived and designed and will be jointly evaluated and disseminated by researchers and practitioners. Uptake of the research findings by other key groups including policymakers, Māori providers and communities and Pacific providers and communities will be supported through key strategic relationships and dissemination activities. Academic dissemination will occur through publication and conference presentations.
Interventional cohort study of prolonged use (>72 hours) of paracetamol in neonates: protocol of the PARASHUTE study
Authors: Haslund-Krog Sissel Sundell , Hertel Steen , Dalhoff Kim , Poulsen Susanne , Christensen Ulla , Wilkins Diana , van den Anker John , Brink Henriksen Tine , Holst Helle
Published: March 2019

Introduction

Anticipated or actual pain in neonates results in use of paracetamol for prolonged pain relief in many neonatal intensive care units. Clinical trials examining safety of paracetamol exposure in neonates have been of short duration (1–3 days) and hepatic biomarkers and paracetamol metabolism are rarely reported in the same studies.

We aim to investigate the safety (hepatic tolerance) and effectiveness of prolonged paracetamol exposure in neonates by measuring hepatic biomarkers, plasma concentrations of paracetamol and its metabolites and pain scores. In addition, we study a possible interaction between ethanol and paracetamol.

Methods and analysis

A multicentre interventional cohort study.

Neonates of any gestational age and up to 44 weeks postmenstrual age, treated with oral or intravenous paracetamol can be included.

Alanine aminotransferase (ALT) and bilirubin are measured at baseline or within 24 hours after treatment initiation. P-paracetamol and metabolites are measured at steady state and every 2 days (opportunistically) together with ALT and bilirubin and lastly after discontinuation of treatment. COMFORT neo pain scores are collected longitudinally. COMFORT neo pain scores and population pharmacokinetic analysis of paracetamol samples will be analysed simultaneously using non-linear mixed effects models. One and two compartment models with first-order elimination will be tested for disposition. In addition, plasma ethanol is measured if the patient receives concomitant treatment with intravenous or oral phenobarbital containing ethanol as an excipient.

Ethics and dissemination

Inclusion of patients can be postponed 24 hours after the first paracetamol dose. This is intended to make the inclusion process less stressful for parents. This study uses standard dosing strategies. The potential risks are additional blood samples, which are collected opportunistically to reduce additional heel pricks.

Trial registrationnumber

Ethics Comittee: H-17027244, EudraCT no: 2017-002724-25, BFH-2017–106, 05952.
Platelet-bound C4d, low C3 and lupus anticoagulant associate with thrombosis in SLE
Authors: Petri Michelle A , Conklin John , O'Malley Tyler , Dervieux Thierry
Published: March 2019

Background

Low C3 and lupus anticoagulant (LAC) are known risk factors for thrombosis in SLE. We evaluated the association between C4d products deposited on platelets (PC4d) and thrombosis in SLE. Antiphosphatidyl serine/prothrombin (PS/PT) complex antibody was also evaluated as an alternative to LAC.

Methods

This was a cross-sectional analysis of 149 consented patients with SLE (mean age: 47±1 years, 86% female) classified with (n=16) or without (n=133) thrombotic events in the past 5 years. Abnormal PC4d (≥20 units) was measured using flow cytometry. LAC and C3 were measured using dilute Russell’s viper venom time (>37 s) and immunoturbidimetry, respectively. Anti-PS/PT antibody status (IgG) was measured by immunoassay. Statistical analysis consisted of logistic regression and calculation of OR estimates with 95% CI.

Results

Abnormal PC4d (OR=8.4, 95% CI 2.8 to 24.8), low C3 (OR=9.5, 95% CI 3.0 to 30.3), LAC (OR=5.4, 95% CI 1.3 to 22.3) and anti-PS/PT IgG (OR=3.4, 95% CI 1.2 to 9.7) status associated with thrombosis (p<0.05). Cumulatively, the presence of PC4d, low C3 and LAC abnormalities as a composite risk score was higher in the presence of thrombosis (1.93±0.25) than in its absence (0.81±0.06) (p<0.01). Each unit of this composite risk score yielded an OR of 5.2 (95% CI 2.5 to 10.7) to have thrombosis (p<0.01). The composite risk score with anti-PS/PT antibody status instead of LAC also associated with thrombosis (p<0.01).

Conclusion

A composite risk score including PC4d, low C3 and LAC was associated with recent thrombosis and acknowledges the multifactorial nature of thrombosis in SLE.
Cerebellar ischaemic infarct: a rare complication of pancreatitis
Authors: Hall Harriet , Valls Sànchez Ferran , Gardini Anna , Corbetta Davide , Florey Jess
Published: March 2019

A 12‐year‐old female neutered Jack Russell terrier was presented for further investigation of an acute two‐day history of lethargy, inappetence and vomiting. Mild increase in urea and amylase and positive cPLI (Canine pancreatic lipase immunoreactivity) ELISA were present. Abdominal ultrasound revealed an irregular, heterogeneous and diffusely hypoechoic pancreas. Severe pancreatitis with secondary peritonitis was diagnosed. Supportive treatment was started, but the patient developed paradoxical vestibular syndrome. MRI was declined and the patient was euthanased. On histopathological examination renal infarction with evidence of thrombosis and focal cerebellar infarction were present. It is well documented that a hypercoagulable state is a known complication of severe pancreatitis. To the authors’ knowledge this is the first description of suspected thromboembolism secondary to pancreatitis resulting in neurological signs in a dog.
Clinical features, anaesthetic management and perioperative complications seen in three horses with pheochromocytoma
Authors: Norgate Daisy Jessica , Foster Andrew , Dunkel Bettina , Spiro Simon , Veres‐Nyeki Kata
Published: March 2019

Three horses presenting with colic signs to the Equine Referral Hospital at The Royal Veterinary College underwent general anaesthesia between September 2013 and November 2017 for emergency exploratory laparotomy. No obvious cause for the colic signs was identified in two horses, while a haemoperitoneum was identified in the third. All horses were euthanased within 12 hours of surgery due to deteriorating haemodynamic instability and/or intractable pain. Postmortem examination revealed an adrenal mass in each case, confirmed to be a pheochromocytoma on histopathology. In retrospect, each horse had some hallmark characteristics consistent with a functional pheochromocytoma, including hyperglycaemia and hyperlactataemia. Extremely high packed cell volume (PCV) (>65 per cent) was also identified in two horses, with a high‐normal PCV found in the haemoperitoneum case. Perioperative haemodynamic instability was predominantly characterised by episodes of intermittent hypertension and tachycardia.
Femoral head ostectomy as a treatment for craniodorsal coxofemoral luxation in an 18‐month‐old Shorthorn heifer
Authors: Snowden Robert T , Anderson David E , Ursini Tena , Mulon Pierre‐Yves
Published: March 2019

An 18‐month‐old, 402‐kg, Shorthorn heifer was presented to the University of Tennessee College of Veterinary Medicine for a chronic craniodorsal coxofemoral luxation. The patient was treated with a femoral head ostectomy of the right hindlimb. Aftercare was provided at the teaching hospital and consisted of pain management to maintain comfort, electrical stimulation to build up the gluteal and femoral musculature, and forced movement. The patient was discharged and is ambulating comfortably at home.
Prosthodontics: preparation and cementation of a full‐coverage metal crown on a fractured maxillary canine tooth
Authors: Thatcher Graham
Published: March 2019

Prosthodontics in veterinary medicine is a discipline in veterinary dentistry in which prosthetic dental appliances are applied in order to maintain and/or restore the function and integrity of the teeth. As it applies to prosthodontics, a crown is a cemented extracoronal restorative that covers part or all of the outer surface of the clinical crown. Full crowns may be recommended by veterinary dentists in order to return a tooth to its normal function, protect it from further damage, or help maintain proper appearance of teeth with significant wear, previous fracture or endodontic treatment. This case report describes the preparation and cementation of a full metal crown for treatment of a compromised maxillary canine tooth in a dog.
Galectin‐3 Is Associated With Stage B Metabolic Heart Disease and Pulmonary Hypertension in Young Obese Patients
Authors: Gopal Deepa M. , Ayalon Nir , Wang Yi‐Chih , Siwik Deborah , Sverdlov Aaron , Donohue Courtney , Perez Alejandro , Downing Jill , Apovian Caroline , Silva Vanessa , Panagia Marcello , Kolachalama Vijaya , Ho Jennifer E. , Liang Chang‐seng , Gokce Noyan , Colucci Wilson S.
Published: March 2019

Background

Obesity is a precursor to heart failure with preserved ejection fraction. Biomarkers that identify preclinical metabolic heart disease (
MHD
) in young obese patients would help identify high‐risk individuals for heart failure prevention strategies. We assessed the predictive value of GAL3 (galectin–3), FSTL3 (follistatin‐like 3 peptide), and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) to identify stage B
MHD
in young obese participants free of clinically evident cardiovascular disease.

Methods and Results

Asymptomatic obese patients (n=250) and non‐obese controls (n=21) underwent echocardiographic cardiac phenotyping. Obese patients were classified as
MHD
positive (
MHD
‐
POS
; n=94) if they had abnormal diastolic function or left ventricular hypertrophy and had estimated pulmonary artery systolic pressure ≥35 mm Hg. Obese patients without such abnormalities were classified as MHD negative (MHD‐NEG; n=52). Serum biomarkers timed with echocardiography.
MHD
‐
POS
and MHD‐NEG individuals were similarly obese, but
MHD
‐
POS
patients were older, with more diabetes mellitus and metabolic syndrome. Right ventricular coupling was worse in
MHD
‐
POS
patients (
P
<0.001).
GAL
3 levels were higher in
MHD
‐
POS
versus
MHD
‐NEG patients (7.7±2.3 versus 6.3±1.9 ng/mL, respectively;
P
<0.001). Both
GAL
3 and
FSTL
3 levels correlated with diastolic dysfunction and increased pulmonary artery systolic pressure but not with left ventricular mass. In multivariate models including all 3 biomarkers, only
GAL
3 remained associated with
MHD
(odds ratio: 1.30; 95%
CI
, 1.01–1.68;
P
=0.04).

Conclusions

In young obese individuals without known cardiovascular disease,
GAL
3 is associated with the presence of preclinical
MHD
.
GAL
3 may be useful in screening for preclinical
MHD
and identifying individuals with increased risk of progression to obesity‐related heart failure with preserved ejection fraction.
Impact of Treatment Modality on Vascular Function in Coarctation of the Aorta: The LOVE‐COARCT Study
Authors: Martins José D. , Zachariah Justin , Selamet Tierney Elif Seda , Truong Uyen , Morris Shaine A. , Kutty Shelby , de Ferranti Sarah D. , Guarino Maria , Thomas Boban , Oliveira Diana , Marinho António , António Marta , Gauvreau Kimberlee , Jalles Nuno , Geva Tal , Carmo Miguel M. , Prakash Ashwin ,   for the LOVE‐COARCT Study
Published: March 2019

Background

Optimally treated patients with coarctation of the aorta remain at risk for late vascular dysfunction. The effect of treatment modality on vascular function is unknown. The LOVE‐COARCT (Long‐term Outcomes and Vascular Evaluation After Successful Coarctation of the Aorta Treatment) study was done to compare vascular function in patients with coarctation of the aorta treated with surgery, balloon dilation (BD), or stent implantation.

Methods and Results

In treated coarctation of the aorta patients without residual coarctation, we prospectively compared aortic stiffness by applanation tonometry and cardiac magnetic resonance; endothelial function by endothelial pulse amplitude testing; blood pressure (
BP
) phenotype by office
BP
, ambulatory
BP
monitoring, and
BP
response to exercise; left ventricular mass by cardiac magnetic resonance; and blood biomarkers of endothelial function, inflammation, vascular wall function, and extracellular matrix. Participants included 75 patients treated with surgery (n=28),
BD
(n=23), or stent (n=24). Groups had similar age at enrollment, coarctation of the aorta severity, residual gradient, and metabolic profile, but differed by age at treatment. Prevalence of systemic hypertension, aortic stiffness, endothelial function, and left ventricular mass were similar among treatment groups. However,
BD
patients had more‐distensible ascending aortas, lower peak systolic
BP
during exercise, less impairment in diurnal
BP
variation, and lower inflammatory biomarkers. Results were unchanged after adjustment for potential confounders, including age at treatment.

Conclusions

In our cohort of patients without residual coarctation, treatment modality was not associated with major vascular outcomes, even though there were some favorable vascular characteristics in the
BD
patients. Although this suggests that choice of treatment modality should continue to be driven by likelihood of achieving a good anatomical result, more long‐term studies are required to assess the clinical significance of the more‐optimal results of secondary markers of vascular function in
BD
patients.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
03262753.
Systematic Incorporation of Sex‐Specific Information Into Clinical Practice Guidelines for the Management of ST‐Segment–Elevation Myocardial Infarction: Feasibility and Outcomes
Authors: Norris Colleen M. , Tannenbaum Cara , Pilote Louise , Wong Graham , Cantor Warren J. , McMurtry Micheal S.
Published: March 2019

Background

Clinical practice guideline (
CPG
) developers have yet to endorse a consistent and systematic approach for considering sex‐specific cardiovascular information in
CPG
s. This article describes an initiative led by the Canadian Cardiovascular Society to determine the feasibility and outcomes of a structured process for considering sex in a
CPG
for the management of ST‐segment–elevation myocardial infarction.

Methods and Results

A sex and gender champion was appointed to the guideline development committee. The feasibility of tailoring the
CPG
to sex was ascertained by recording (1) the male–female distribution of the study population, (2) the adequacy of sex‐specific representation in each study using the participation/prevalence ratio, and (3) whether data were disaggregated by sex. The outcome was to determine whether recommendations for
CPG
s based on an assessment of the evidence should differ by sex. In total, 175 studies were included. The mean percentage of female participants reported in the studies was 24.5% (
SD
: 6.6%; minimum: 0%; maximum: 51%). The mean participation/prevalence ratio was 0.62 (
SD
: 0.16; minimum: 0.00; maximum: 1.19). Eighteen (10.2%) studies disaggregated the data by sex. Based on the participation/prevalence ratio and the sex‐specific analyses presented, only 1 study provided adequate evidence to confidently inform the applicability of the
CPG
recommendations to male and female patients.

Conclusions

Implementing a systematic process for critically appraising sex‐specific evidence for
CPG
s was straightforward and feasible. Inadequate enrollment and reporting by sex hindered comprehensive sex‐specific assessment of the quality of evidence and strength of recommendations for a
CPG
on the management of ST‐segment–elevation myocardial infarction.
An Experimental Investigation of the Effects of Retargeted Advertising: The Role of Frequency and Timing
Authors: Sahni Navdeep S. , Narayanan Sridhar , Kalyanam Kirthi
Published: March 2019

In collaboration with an online seller of home-improvement products, the authors conduct a large-scale randomized field experiment to study the effects of retargeted advertising, a form of internet advertising in which banner ads are displayed to users after they visit the advertiser’s website. They find that switching on experimental retargeting causes 14.6% more users to return to the website within four weeks. The impact of retargeting decreases as the time since the consumer first visited the website increases—indeed, 33% of the effect of the first week’s advertising occurs on the first day. Furthermore, the authors find evidence of the existence of complementarities in advertising over time: the effect of advertising in week 2 of the campaign is higher when the user was assigned to a nonzero level of advertising in week 1. The authors discuss mechanisms that can explain their findings and demonstrate a novel low-cost method that can be applied generally to conduct valid online advertising experiments.
Promoting the use of outcome measures across disciplines through action research with practitioners in a palliative care setting
Authors: Reynolds Sarah , Bannigan Katrina
Published: March 2019

Background/Aim

Allied health professionals aspire to become evidence-based practitioners but disparity exists between best practice and clinical practice. One example is outcome measurement; despite being committed to using outcome measures, allied health professionals struggle to use them. This study aimed to explore the process of introducing outcome measures into a practice setting.

Methods

A qualitative action research study was undertaken with allied health professionals working in a hospice setting. The data, collected in three cycles of action, were analysed thematically.

Findings

Three themes emerged: the gap between knowledge and practice, the challenges of measuring outcomes in palliative care, and facilitators to using outcome measures in palliative care. Action research provided a structure to involve therapists in introducing outcome measures within a practice setting.

Conclusions

This study provides insight into how a clinical speciality's discrete characteristics influence the process of selecting outcome measures. In a hospice setting, where people have life-shortening conditions, the challenges for using outcome measures are different to other settings. Action research offers a deep learning opportunity and process, through education, discussion, and critique, to support therapists to select and adopt the outcome measures to use in practice.
Melatonin in Periodontal Diseases: A Review
Authors: Sankari M. , Meenakshi S. Swarna
Published: March 2019

Melatonin is a substance that is secreted by multiple organs in Humans. In addition to playing a role in the regulation of the circadian cycle, it is also known to have antioxidant, antiinflammatory, and antioncotic effects on human tissues. Oral cavity is an easy target for many conditions such as periodontitis, mucositis, cancers, and cytotoxicity from various drugs or biomaterials. Research on melatonin as a therapeutic agent has suggested that it is effective in treating the aforementioned pathologic conditions effectively. Furthermore, melatonin tends to favour bone regeneration by behaving as an osteoconductive scaffold. The aim of this review is to summarize the uses and potential of melatonin in management of periodontal diseases.
Wound Healing Activity of Alcoholic Extract of Tamarix Aphylla L. on Animal Models
Authors: Ali Sajid , Alam Sarfaraz , Ahmad Sarfaraz , Ali Maksood , Ahsan Waquar , Raza Siddiqui Masoom , Ansari Salahuddin , Shamim Shamim , Daud Ali Mohammad
Published: March 2019

To evaluate the wound healing activity of ethanolic extract of Tamarix aphylla L. on animal model. Wound creation like circular excision and linear incision method were considered for this study. The various parameters were studied like DNA estimation, total protein estimation, estimation of Hexosamine and Uronic acid, estimation of lipid peroxides and antioxidant activity, Tensile Strength of tissues from incision wounds, Antioxidant activity, Antimicrobial activity, Period of epithelialization and finally TNF-a concentration in the wound tissue homogenate were estimated. The treatment groups with the extract showed significant antimicrobial activity with compare to the standard drug. Significantly, 93. 86% increase in the collagen content and significant 52% up regulation in tensile strength was observed in the treated group. 40% reduction was observed in epithelialization period of the treated wounds. The results of the current study confirm that the ethanolic extract of T. aphylla has potent wound healing capacity.
Effect of Methanolic Extract of Phyllanthus niruri on Leptin Level in Animal Model of Diabetes Mellitus
Authors: Kumar Anuj , Kumar Rana Akhilesh , Singh Amit , Singh Alok
Published: March 2019

To study the effect of methanolic extract of Phyllanthus niruri on animal model of Diabetes Mellitus. Diabetes Mellitus was induced in rats by injecting Streptozotocin (60mg/kg) intraperitonealy. Blood glucose was measured on day 3 by GOD-POD method. Rats having fasting blood glucose >250 mg/dl were further selected for study. Four groups were created i.e. Control, Control+Streptozotocin, Streptozotocin+ Metformin(75mg/kg) and Streptozotocin+ extract of P. niruri (250mg/kg). Each group was consisting of 6 rats of either sex. Metformin and experimentalextract were administered for 21 days. Blood Glucose was measured on day 7 and 21. Triglyceride, Cholesterol and Leptin level were also measure by commercially available kit. Anti-oxidant potential was assessed by estimating extent of Lipid peroxidation (LPO) by Malondialdehyde (MDA), Nitric oxide (NO), Superoxide dismutase (SOD) and Glutathione (GSH) in four different tissues i.e. Liver, Kidney, Pancreas, Muscle on day 21. Unpaired and paired student’s t-test were applied for statistical analysis using SPSS Software. The extract of P. niruri showed significant decrease in blood glucose level on day 21 (p-0.04). The treatment didn’t show significant lowering of Leptin and Cholesterol level however Triglyceride level was significantly reduced (p-0.05). The treatment group showed improvement in oxidative stress by increasing SOD and GSH and decreasing LPO and NO activity. The study showed anti-hyperglycemic and anti-oxidative properties of methanolic extract of P.niruri.
Heteroxenia Ghardaqensis Extract Protects Against DNA Damage in Streptozotocin-Induced Experimental Diabetes
Authors: Razik Farrag Abdel , Nassar Mahmoud , El-Khayat Zakaria , Hussein Jihan , Ahmed Mohammed Nadia , Medhat Dalia , El-Gendy Abd El-Nasser , Elshamy Abdelsamed
Published: March 2019

DNA damage is correlated to type-2 diabetes mellitus (T2DM) and its complications via oxidative stress. This study aimed to evaluate the anti-diabetic effect of Heteroxenia ghardaqensis extract on streptozotocin (STZ) induced-diabetes and how far can this extract attenuate DNA damage in this model. Forty male albino rats (160-180 g) were used in this study and divided into four groups: control, diabetic, diabetic rats received H. ghardaqensis extract (30 mg/kg body weight/day) orally for four weeks and diabetic rats received H. ghardaqensis extract (60 mg/kg body weight/day) orally for four weeks. After the experimental period, fasting blood sugar and serum cholesterol were determined. Urinary 8-hydroxyguanosine (8-OHdG) as a marker of DNA damage was estimated by reversed phase (HPLC). Liver and kidney nitic oxide (NO) and malondialdehyde (MDA) were estimated. Pancreatic tissues were histopathologicaly examined. Our results suggested that diabetes mellitus is accompanied by elevation of DNA damage that enhances the tendency to mutagens and reduce the efficacy of DNA repair. H. ghardaqensis extract appeared to be effective against the oxidative stress induced by STZ which may be due to sesquiterpenoids and diterpenes compounds that scavenge free radicals and increase the antioxidant enzymes as appeared in attenuation of DNA damage.
Lung Cancers and the Roles of Natural Compounds as Potential Chemotherapeutic and Chemopreventive Agents
Authors: Surien Omchit , Rohi Ghazali Ahmad , Fathiah Masre Siti
Published: March 2019

Among all types of human cancers, lung cancer is one of the most common and has the highest mortality rate. Two major groups of lung cancer based on histological features are non-small cell lung cancers (NSCLCs) and small cell lung cancers (SCLCs). NSCLCs are further subdivided into few subtypes such as adenocarcinoma (AD), squamous cell carcinoma (SCC) and large cell carcinoma(LCC). Focusing on specific treatments or molecular targeted therapy for each type of lung cancers promising the better results as each subtype of lung cancers differ in genomic alterations, the cell of origin and growth pattern. Numerous studies have been done to search for the best chemotherapeutic and chemopreventive agents that can reduce the burden of lung cancer, primarily focusing on potential natural products. This review is focused on genomic alterations and current potential natural compounds as chemotherapeutic and chemoprevention agents specifically on each subtype of lung cancers.
Supplementation of Water Extract of Purple Sweet Potato (Ipomoeo Batatas L) in Improving the EEG Image, Decreasing the Seizure Frequency and Reducing the Frequency of Drugs Resistant of Focal Epilepsy in Children
Authors: Ngurah Made Suwarba I. Gusti , Soetjiningsih Soetjiningsih , Bakta I. Made , Jawi I. Made , Made Sukrama I. Dewa , Putu Sutirta Yasa I. Wayan , Mangunatmadja Irawan
Published: March 2019

The water extract of purple sweet potato contains of anthocyanin, a sub-class of flavonoid that has powerful antioxidant, antiinflammatory, and anticonvulsant effect. The aim of this study was to determine the effectiveness of supplementation of water extract of purple sweet potato towards recovery (remission) of drug resistant focal epilepsy (DRFE) in children with standard conventional antiepileptic medicine. It was found that the supplementation of purple sweet potato extract had a pure effect in improving all of the dependent variables, including decreased of the serum level of 8-OHdG by 1.611 pg/mL (p<0.001); decreased the serum level of IL-6 by 3.320 pg/mL (p<0.001); increased the total SOD serum level by 0.208 IU/mL (p=0.003); improved the EEG image (p=0.004); and decreased the seizure frequency at the end of the sixth week by 3.972 times (p<0.001), compared to the control. There is a significant effect on the use of supplementation of purple sweet potato extract in decreasing the serum level of 8-OHdG, decreasing the serum level of IL-6, increasing the total SOD serum level, improving the EEG image, decreasing the seizure frequency at the end of the sixth week, which at the end reducing the frequency of drugs resistant of focal epilepsy in children.
Novel Drug Delivery Systems for Rheumatoid Arthritis: An Approach to Better Patient Compliance
Authors: Mohanty Sangeeta , Panda Sthitapragnya , Bhanja Aslesha , Pal Abhisek , Chandra Si Sudam
Published: March 2019

Recent advances in science and technology radically changed the way we detect, treat and prevent different diseases in all aspects of human life. Rheumatoid arthritis (RA) is a chronic, systemic, progressive, autoimmune disease in which the body’s immune system whose major role is to protect the health by attacking foreign bacteria and viruses are mistakenly, attacking the joints resulting in thickened synovium, pannus formation, & destruction of bone, cartilage. Still now researchers are unable to know the exact cause of this disease. However, it is believed that genes and environmental factors play a role in development of RA. In this review, we discuss the Pathophysiology, predictors, & factors involved in pathogenesis of RA. We also discuss the Conventional therapeutic agents for Rheumatoid Arthritis. More importantly, we extensively discuss the emerging novel drug delivery systems (NDDS) like nanoparticles, dendrimers, micelles, microspheres, liposomes, and so on as these are the promising tools having successful applications in overcoming the limitations associated with conventional drug delivery systems. Although several NDDS have been used for various purposes, liposomes have been focused on due to its potential applications in RA diagnosis and therapy. In addition, we discuss the therapeutic effectiveness and challenges for RA by using these novel drug delivery systems. Finally, we conclude by discussing the future perspectives.
The use of the Adaptive and the Maladaptive Cognitive Emotion Regulation Strategies by Nurses Student in Morocco Facing to the Patient Death in a Clinical Setting
Authors: Bandadi Lahcen , Chamkal Nadia , Belbachir Siham , T. Ahami Ahmed O.
Published: March 2019

The purpose of this study is to describe the adaptive and the maladaptive cognitive emotion regulation strategies used by nurse’s student having experienced the death of a patient in a clinical setting. The study was conducted in the Institute of Nursing and Technical Health of Rabat in Morocco. To carry out this study, 64 nurses student from license cycle have recruited (56,2% female, 43,8% male). 37,5% nurses student are from semester two and 62,5% are from the final semester (S6). The mean age is 20,33±1,67. The tool used to conduct this study is the Cognitive Emotion Regulation Strategies Questionnaire. For the all group, the students use less the adaptive cognitive regulation strategies. However we could say that the use of maladptaive cognitive emotion regulation strategies is in the norms. There was significant difference between males and females in terms of catastrophizing (p<0,001), self-blame (p=0,01), rumination (p=0,04) with a high scores among females. Compared to the nurses student from the semester two, the nurses student from the final semester had law self-blame, law catastrophizing, law rumination, and high positive refocusing. The study shows that, facing to the death, nurses student underutilized the adaptive cognitive emotion regulation strategies. The use of the maladaptive cognitive emotion regulation strategies is in the norms. However, significant differences related to the gender and to the study level were observed. These results show the great interest of intervention to promote the cognitive emotion regulation strategies while taking into account the gender approach. Other studies are also essential to deepen this aspect to see the impact of its strategies on nurses students' psychological health as well as on their performance.