bluuebunny/crossref_metadata_2025_split huggingface dataset:
The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy
Authors: Zhu Jingli , Wang Xue-ting , Gong Jing , Sun Hai-bin , Zhao Xiao-qing , Gao Wei 
Published: September 2019

Abstract
Background Splenectomy performed with a curved incision results in severe postoperative pain. The aim of this study was to evaluate the effect of transversus abdominis plane block and rectus sheath block on postoperative pain relief and recovery.Methods A total of 150 patients were randomized into control (C), levobupivacaine (L) and levobupivacaine plus morphine (LM) groups. The patients in the C group received only patient-controlled analgesia. The patients in the L and LM groups received transversus abdominis plane block and rectus sheath block with levobupivacaine or levobupivacaine plus morphine. The intraoperative opioid consumption; postoperative pain score; time to first analgesic use; postoperative recovery data, including the times of first exhaust, defecation, oral intake and off-bed activity; the incidence of postoperative nausea and vomiting and antiemetics use; and the satisfaction score were recorded.Results Transversus abdominis plane block and rectus sheath block reduced intraoperative opioid consumption. The patients in the LM group showed lower postoperative pain scores, opioid consumption, postoperative nausea and vomiting incidence and antiemetic use and presented shorter recovery times and higher satisfaction scores.Conclusions Transversus abdominis plane block plus rectus sheath block with levobupivacaine and morphine can improve postoperative pain relief, reduce the consumption of analgesics, and partly accelerate postoperative recovery.
Danish Evaluation of Your Heart Forecast (DANY) - Study Protocol for a Randomised Controlled Trial on an Interactive Risk-communication Tool aimed at improving High Blood Pressure Patients’ adherence.
Authors: Jensen Anders Elkær , Søndergaard Jens , Kjær Niels Kristian , Jackson Rod , Nielsen Jesper Bo 
Published: September 2019

Abstract
Background

To improve communication of risk messages, they must be communicated in a way that is understandable and relevant to the patient. Communicating risk of cardio-vascular-disease is a complex and individualised task, since the risk itself is a combination of multiple personal risk factors. Raised blood pressure is but one of these risk factors. In Denmark, one third of hypertensive patients are adequately treated, with regards to national guidelines. One reason for this meagre status is low treatment adherence, and tools with documented effects for increasing patient adherence are limited.

Our objective is to evaluate the effect of a personalised, interactive and dynamic risk-assessment and risk-communication tool: “Your Heart Forecast” on blood pressure control, primary non-compliance, health literacy and patient empowerment.Methods

Cluster-randomised controlled trial in general practice. Effect measures are adherence, blood pressure, lipid levels and empowerment at inclusion and after 6 and 12 months. To identify other benefits or possible adverse effects of the intervention, qualitative interviews will be conducted with a subgroup of patients. Discussion

The investigators will explore effects of Your Heart Forecast on patients’ health literacy, adherence, empowerment and blood pressure control. The DANish evaluation of Your heart forecast (DANY) project will be the first to rigorously evaluate effects of YHF in Denmark and to link adherence of hypertensive patients exposed to Your Heart Forecast with the national databases of prescriptions and health services provided.
Monitoring in practice – How are UK academic clinical trials monitored? A survey
Authors: Love Sharon , Yorke-Edwards Victoria , Lensen Sarah , Sydes Matthew R 
Published: September 2019

Abstract
Background

Despite the FDA and EMA encouraging the use of risk-based monitoring for trials in 2013, there remains a lack of evidence-based guidelines on how to monitor. We surveyed the academic United Kingdom Clinical Research Collaboration (UKCRC) registered clinical trials units (CTUs) to find out their policy on monitoring of phase III randomised CTIMP trials.

Methods

An online survey of monitoring policy with sections on the CTU, central monitoring and on-site monitoring was sent to all 50 UKCRC registered CTUs in November 2018. Descriptive data analysis and tabulations are reported using the total number answering each question.

Results

43/50 (86%) of CTUs responded with 38 conducting phase III randomised CTIMP trials. Of these 38 CTUs, 34 finished the survey. Most CTUs (36/37, 97%) use a central monitoring process to guide, target or supplement site visits. More than half (19/36, 53%) of CTUs do not use an automated monitoring report when centrally monitoring trials and all units use trial team knowledge to make a final decision on whether an on-site visit is required. 31/34 (91%) CTUs used triggers to decide whether or not to conduct an on-site monitoring visit. On-site, a mixture of Source Data Verification and checking of processes was carried out. The CTUs overwhelmingly (27/34, 79%) selected optimising central monitoring as their most pressing concern.

Conclusion

The survey showed a wide variation in Phase III randomised CTIMP trial monitoring practices by academic clinical trials units within a single research-active country. We urgently need to develop evidence-based regulator agreed guidance for CTUs on best practice for both central and on-site monitoring and to develop tools for all CTUs to use.
The prevalence and risk factors associated with hypertension subtypes among ethnic Dai adults in rural China
Authors: Zhong Hua , Dong Yulong , Tao Yijin , Pan Chen-Wei , Peng Yunzhu , Cai HongYan , Li Jun , Wang Yanmei , Wang Huawei , Sheng Xun , Wang Feng , Chen Lixing 
Published: September 2019

Abstract
Objective
Hypertension is an important risk factor for cardiovascular disease. The purpose of this survey was to determine the prevalence of hypertension subtypes and the risk factors associated with hypertension subtypes among ethnic Dai adults in rural China.
Methods
A population-based survey was carried out with 2150 rural inhabitants aged 50 years or older. The definition of hypertension was a systolic blood pressure (SBP) ≥140 mmHg and/or a diastolic blood pressure (DBP) ≥90 mmHg, or a current treatment plan with an antihypertensive medication. Hypertension included the following subtypes: systolic–diastolic hypertension (SDH), isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH). All participants were interviewed, had physical examinations performed, and had blood pressure measurements taken. Multivariate logistic regression analysis was applied to analyse the risk factors for hypertension.
Results
The prevalence of HBP was 43.2% (95% CI: 41.1-45.3). The subtype-specific prevalence of hypertension was 16.5% (95% CI: 14.9-18.0) for SDH, 24.2% (95% CI: 22.4-26.0) for ISH and 2.5% (95% CI: 1.9-3.2) for IDH. Among hypertensive participants, 37.9% were SDH, 56.8% were ISH and 5.8% were IDH. Older age is a risk factor for HBP and ISH. Obesity, smoking, drinking and history of hypertension are risk factors for HBP, SDH, ISH and IDH (OR>1). Of the hypertensive participants, the awareness of hypertension in our study was 25.0% for HBP, 34.7% for SDH, 20.0% for ISH and 9.3% for IDH. The rates of treatment and control were 23.8% and 6.9% for HBP, 26.8% and 7.9% for SDH, 23.1% and 6.3% for ISH and 11.1% and 5.6% for IDH, respectively.
Conclusions
Among Dai people in rural China, the prevalence of hypertension is high, and the awareness, treatment and control of hypertension is low. ISH is the most frequent kind of high blood pressure in rural elderly people. With the ageing population in China, ISH remains an important public health problem and a challenging issue for practising physicians in rural China. Public health strategies should regularly provide more information about hypertension to both the local physicians and the general population. To reduce cardiovascular events, a combination of drugs and lifestyle changes are strongly recommended.
Survival status and predictors of undesirable treatment outcome of children with severe acute malnutrition admitted to Yekatit 12 hospital medical college from 2013-2016, Addis Ababa, Ethiopia: a retrospective cohort study.
Authors: Negussie Absalat Serawit , Tadesse Amare Worku 
Published: September 2019

Abstract
Background Globally, in 2015, malnutrition contributes to 45% of all child deaths. These early child deaths are due to conditions that could be prevented or treated with access to simple and affordable interventions. Hence, this study intends to provide a quantitative summary of treatment outcomes and to identify factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM) admitted to Yekatit 12 hospital from the year 2013 to 2016.Methods A retrospective cohort of 304 children aged 6-59 months old with complicated SAM admitted to Yekatit 12 teaching hospital from 2013- 2016 were studied. Data on nutritional status, socio-demographic factors and admission medical condition were extracted. Data were analyzed using SPSS version 20. Kaplan-Meier was employed to estimate the recovery rates of the children treated for SAM and Cox regression was used to control for confounding.Result From overall (n = 304) under-five children with SAM, 133 (51.4%) were males and 126 were (48.6%) females. Marasmus was the most common type of severe acute malnutrition 132(51%). The recovery, death and defaulter rate were 70.4%, 12.2% and 8.2% respectively. The main predictors of undesirable outcome were HIV antibody positive children (AHR=3.208; 95% CI: [1.045-9.846]) and sepsis (AHR= 7.677, 95% CI: [2.320-25.404])Conclusion The study revealed that the overall treatment outcomes were below the SPHERE standard recommendation and the main predictors of death in children receiving in-patient treatment for SAM were HIV and sepsis. Intervention to reduce death should focus on institutional care.
Factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal demographic and health survey
Authors: Sunuwar Dev Ram , Singh Devendra Raj , Pradhan Pranil Man Singh 
Published: September 2019

Abstract
Background
Double and triple burden of malnutrition is defined by the coexistence of overweight/obese mother and undernourished child and coexistence of overweight/obese mother and undernourished and anemic child at the same household level respectively. The aims of this study were to explore the coexistence of overweight/obesity among mothers and undernourished and anemia among children and associated factors among the mother-child pairs in the same household.
Methods
A total sample of 5018 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements, hemoglobin level of the children and their mothers were taken. The bivariate and multivariate logistic regression were performed to observe the factors associated with the double and triple burden of malnutrition. To assess the outcome, we created the categories such as the double and triple burden of malnutrition where the overweight/obese mother and undernourished (stunted or wasted or underweight) child and overweight/obese mother and undernourished (stunted or wasted or underweight) child and anemic child respectively.
Results
Prevalence of double burden of malnutrition (DBM) and triple burden of malnutrition (TBM) was 6.59(5.13-8.84)% and 7(5.42-8.99)% respectively at the same household. In the adjusted multivariate logistic regression, mothers with short stature (AOR=3.94, 95% CI: 1.94-8.00), from the richest wealth status (AOR=2.59, 95% CI= 1.27-5.28), age groups of 26-49 years (AOR=2.38, 95% CI: 1.18-4.77), attended at least a secondary level of education (AOR=1.93, 95% CI: 1.01-3.69) were more likely to have the double burden of malnutrition. Similarly, mothers who had short stature (AOR=4.48, 95% CI: 2.19-9.16), the richest wealth status (AOR=2.46, 95% CI= 1.19-5.08) and age groups of 26-49 years (AOR=2.27, 95% CI: 1.16-4.44) were more likely to suffer from the triple burden of malnutrition.
Conclusions
Our study concludes with the prevalence of double and triple burden of malnutrition existence among mothers and children in Nepal. Mothers having short stature and from the richest family are more prone to double and triple burden of malnutrition. Integration of maternal health promotion and nutrition education program would be a good strategy to prevent mother overweight/obesity and stunting among children under five years of age in Nepal.
Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia
Authors: Borzie Korpo , Jasper Noah , Southall David , MacDonald Rhona , Kola Adeyemo Abass , Dolo Obed , Magnus Asinya , Watson Diane , Casement Maire , Dahn Bernice , Jallah Wilhelmina 
Published: September 2019

Abstract
Background: In low-resource settings with few health workers, the Fetal Heart Rate (FHR) in women in labour can be inadequately monitored contributing to poor outcomes. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia with extremely limited health workforces, to assess the feasibility of educating women in labour to monitor their FHR and alert their attending midwife of any changes which might indicate fetal distress.
Methods and Interventions: Over 15 months, 474 women admitted in labour without obstetric complications were approached. After informed consent, 461 agreed (97%) and 13 refused. Those consented were trained to monitor the FHR using a sonicaid for approximately one minute immediately after the end of every uterine contraction and inform her midwife of changes. If relevant changes were confirmed, standard clinical interventions for possible fetal distress (lateral tilt and intravenous fluids and glucose) and, when appropriate, accelerated delivery by vacuum or Caesarean section were undertaken. Participants provided views on their monitoring experience; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.
Results: 461 out of 474 women gave consent, of whom 426 (92%) completed the monitoring themselves. 386 (97%) of 400 who gave comments, reported positive experiences and 14 reported only negative experiences. 28 participants identified FHR changes, confirmed in 26 cases. Meconium stained liquor accompanied FHR changes in 18 of these 26 (69%). 13 of these 26 neonates required resuscitation, with 10 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes. One (birth weight 1.3 Kg) could not be resuscitated. There were no intrapartum stillbirths or maternal deaths in participants.
Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience positive and empowering. The absence of intrapartum stillbirths and low number of poor neonatal outcomes are promising but warrant further research.
Major obstetric haemorrhage in Metro East, Cape Town, South Africa: a population-based cohort study using the Maternal Near Miss approach
Authors: Heitkamp Anke , Aronson Simcha Lot , Akker Thomas van den , Vollmer Linda , Gebhardt Stefan , Roosmalen Jos van , de Vries Johanna I , Theron Gerhard 
Published: September 2019

Abstract
Background Major obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in the whole of Africa. We aimed to assess population-based incidence, causes, management and outcomes of major obstetric haemorrhage and risk factors associated with poor maternal outcome. Methods Women with major obstetric haemorrhage who met WHO Maternal Near-Miss criteria or died in Metro East region, Cape Town, South Africa, were evaluated from November 2014-November 2015. Major obstetric haemorrhage was defined as haemorrhage in pregnancies of at least 20 weeks’ gestation or occurring up to 42 days after birth and leading to hysterectomy or blood transfusion of ≥5 units of Packed Red Blood Cells or hypovolemic shock. A logistic regression model was used to analyse associations with poor outcome, defined as major obstetric haemorrhage leading to massive transfusion of ≥8 units of packed red blood cells, hysterectomy or death. Results Incidence of major obstetric haemorrhage was 3/1000 births, and incidence of massive transfusion 4/10.000 births in Metro East region (32.862 birth in the studied time period). Leading causes were placental abruption 45/119 (37.8%), complications of caesarean section 29/119 (24.4%) and uterine atony 13/119 (10.9%). Therapeutic oxytocin was administered in 98/119 (82.4%) women and hysterectomy performed in 33/119 (27.7%). Median numbers of packed red blood cells and units of Fresh Frozen Plasma transfused were 6 (interquartile range 4-7) and 3 (interquartile range 2-4), ratio 1.7:1. Caesarean section was independently associated with poor maternal outcome: adjusted OR 4.01 [95% CI 1.58, 10.14] Conclusions Assessment of major obstetric haemorrhage using the Maternal Near Miss approach revealed that placental abruption and complications of caesarean section were the major causes of major obstetric haemorrhage. Caesarean section was associated with poor outcome.
Indigenous rice of Northeast India harbor rich genetic diversity as measured by SSR markers and Zn/Fe content
Authors: Surname Vanlalsanga No , Singh Sagolshem Priyokumar , Singh Yengkhom Tunginba 
Published: September 2019

Abstract
Background

Rice (Oryza sativa L.) is one of the most important crops of the world and a major staple food for half of the World’s human population. The Northeastern (NE) region of India lies in the Indo-Burma biodiversity hotspot and about 45% of the total flora of the country is found in the region. Local rice cultivars from different states of NE India were analyzed for genetic diversity and population structure using microsatellite markers, and their zinc and iron content.

Results

A total of 149 bands were detected using twenty-two microsatellite markers comprising both random and trait-linked markers, showing 100% polymorphism and high value of expected heterozygosity (0.6311) and the polymorphism information content (0.5895). Nali Dhan cultivar of Arunachal Pradesh possessed the highest genetic diversity (0.3545) among studied populations while Moirangphou Khonganbi of Manipur exhibited the lowest genetic diversity (0.0343). The model-based population structure revealed that all the studied 65 rice cultivars were grouped into two clusters. Cluster I was represented by 36 cultivars and cluster II by 29 cultivars. Badalsali cultivar of Assam possessed the highest Zn content (75.8 μg/g) and Kapongla from Manipur possessed the lowest (17.98 μg/g). The highest and the lowest Fe content was found in Fazu (215.62 μg/g) and Idaw (11.42 μg/g) of Mizoram.

Conclusion

The result suggested rice cultivars of NE India possessing high genetic diversity (Nali Dhan), high Zn (Badalsali) and Fe (Fazu) content can be useful as a source of germplasm for future rice improvement programs.
Risk literacy assessment of general practitioners and medical students using the Berlin Numeracy Test
Authors: Friederichs Hendrik , Birkenstein Roman , Becker Jan C. , Marschall Bernhard , Weissenstein Anne 
Published: September 2019

Abstract
Background

Responsibility for helping patients understand potential health benefits and risks falls largely to general practitioners (GPs), especially for screening tests. The Berlin Numeracy Test (BNT) specifically measures risk literacy, meaning the range of statistical numeracy associated with accurate interpretation of information about risks. This study explored the association between the level of risk literacy and clinical experience, and risk literacy’s impact on evaluating the predictive value of screening tests.

Methods

The participants were 84 GPs and 92 third-year medical students who completed the BNT (total score range 0–4 points). For the GPs an additional case scenario on mammography screening was given as a simple measure of performance in applying numeracy skills.

Results

Despite having an average of 25.9 years clinical experience, GPs scored no better than did medical students on risk literacy (GPs: 2.33 points, 95% CI 2.08–2.59; students: 2.34, 95% CI 2.07–2.61; P = .983). Of all GPs, 71.6% (n = 58) came to the opposite conclusion of the real predictive value.

Conclusions

In this study, we found no difference in risk literacy between current students and current GPs. GPs lack risk literacy and in consequence do not fully understand numeric estimates of probability of routine screening procedures.
Are there any Connections between Adrenal Myelolipoma and Hypertension?
Authors: Lin Lede , Gong Lina , Sun Wenjin , Cheng Liang , Li Hong , Wang Kunjie , Zhu Yuchun 
Published: September 2019

Abstract
Background. Adrenal myelolipoma (AML) is a non-functional benign neoplasm from adrenal cortex, composed of mature fat and hematopoietic tissue. Usually, patients have no symptoms. However, some present with hypertension and blood pressure normalizes after surgery, indicating some connections between AML and hypertension.
Methods . This is a retrospective cohort study of 372 patients diagnosed with AML from September 2008 to December 2018 collected in Urology Department of West China Hospital, Chengdu, Sichuan, China. We collected clinical records of patients before surgery and partial patients were done with hormone examination. Postoperative follow-up was also done for those with hypertension and whether patients needed to take antihypertensive drugs and postoperative blood pressure were recorded. We aim to explore the characteristics of both AML patients with hypertension and remission of hypertension in 1 year after surgery.
Results. There were 372 AML patients included in the study, 159 males and 213 females, aged 49.77±11.64 years old. Among them, 118 patients presented with hypertension. The percentage of hypertension in each subgroup increased with age. Sixty patients were followed up for 1 to 9 years, with a median follow-up of 52 months. The course of hypertension in the remission group was shorter than that in the non-remission group (P=0.020), and tumor lateralization was significantly different between two groups (P=0.005).
Conclusion. Nearly one third of AML patients suffered from hypertension in our study and there do exist some potential links between AML and hypertension.