Participant clinicopathological features are more consistent with contemporary patient characteristics than in previous prostate cancer treatment trials .


We examined the therapeutic effects of avanafil @ minutes after dosing in men with mild to severe erectile dysfunction .


This randomized , double-blind , placebo controlled , @-week study ( @-week run-in and @-week treatment ) randomized @ men to placebo , @ to avanafil @ mg and @ to avanafil @ mg on demand .


The primary efficacy variable was the per subject proportion of sexual attempts during the treatment period in which subjects achieved erection sufficient for vaginal penetration within approximately @ minutes after dosing as measured by a stopwatch .


The attempt had to enable successful completion of sexual intercourse according to SEP question @ .


Significantly greater mean per subject percentages of successful intercourse attempts within approximately @ minutes after dosing were observed for avanafil @ mg ( mean @ % , LS mean SE @ % @ % ) and @ mg ( mean @ % , LS mean @ % @ % ) vs placebo ( mean @ % , LS mean @ % @ % , p = @ and < @ , respectively ) .


After treatment we noted a statistically significant difference between avanafil and placebo in the average per subject proportion of successful intercourse attempts according to SEP question @ as early as @ minutes in the @ mg group and @ minutes in the @ mg group .


Treatment emergent adverse events included headache , upper respiratory tract infection and nasal congestion , and most such events were mild or moderate in severity .


Avanafil was efficacious within approximately @ minutes of dosing compared to placebo .


A statistically significant treatment difference in the percentage of successful sexual attempts was demonstrated as early as @ minutes after treatment .


The objective of this study was to compare the efficacy and comfort of inelastic bandages ( IBs ) and adjustable Velcro compression devices ( AVCDs ) in reducing venous leg edema in the initial treatment phase .


Forty legs from @ patients with untreated venous edema ( C@EpsAsdPr ) were randomized to two groups .


Patients in the first group received IBs ( n = @ ) and those in the second AVCDs ( n = @ ) .


Both compression devices were left on the leg day and night , and were renewed after @ day .


Patients in the AVCD group were asked to re-adjust the device as needed when it felt loose .


Leg volume was calculated using the truncated cone formula at baseline ( T@ ) , after @ day ( T@ ) and after @ days ( T@ ) .


The interface pressure of the two compression devices was measured by an air filled probe , and the static stiffness index calculated after applying compression at T@ and T@ , and just before removal of compression on T@ and T@ .


Patient comfort with regard to the two compression systems was assessed by grading signs and symptoms using a visual analog scale .


At T@ , the median percent volume reduction was @ % for the IB group versus @ % for the AVCD group ; at T@ it was @ % versus @ % , respectively ( p < @ ) .


The pressure of the IBs was significantly higher compared with the AVCDs at T@ ( @ vs. @ mmHg ) but dropped by > @ % over time , while it remained unchanged with AVCDs owing to the periodic readjustment by the patient .


Comfort was reported to be similar with the two compression devices .


Re-adjustable AVCDs with a resting pressure of around @ mmHg are more effective in reducing chronic venous edema than IBs with a resting pressure of around @ mmHg .


AVCDs are effective and well tolerated , not only during maintenance therapy , but also in the initial decongestive treatment phase of patients with venous leg edema .


Gastroparesis is common in surgical patients and frequently leads to the need for enteral tube feeding .


Nasoenteral feeding tubes are usually placed endoscopically by gastroenterologists , but this procedure is relatively cumbersome for patients and labor-intensive for hospital staff .


Electromagnetic ( EM ) guided bedside placement of nasoenteral feeding tubes by nurses may reduce patient discomfort , workload and costs , but randomized studies are lacking , especially in surgical patients .


We hypothesize that EM guided bedside placement of nasoenteral feeding tubes is at least as effective as endoscopic placement in surgical patients , at lower costs .


The CORE trial is an investigator-initiated , parallel-group , pragmatic , multicenter randomized controlled non-inferiority trial .


A total of @ patients admitted to gastrointestinal surgical wards in five hospitals , requiring nasoenteral feeding , will be randomly allocated to undergo EM guided or endoscopic nasoenteral feeding tube placement .


Primary outcome is reinsertion of the feeding tube , defined as the insertion of an endoscope or tube in the nose/mouth and esophagus for ( re ) placement of the feeding tube ( e.g. after failed initial placement or dislodgement or blockage of the tube ) .


Secondary outcomes include patient-reported outcomes , costs and tube ( placement ) related complications .


The CORE trial is designed to generate evidence on the effectiveness of EM guided placement of nasoenteral feeding tubes in surgical patients and the impact on costs as compared to endoscopic placement .


The trial potentially offers a strong argument for wider implementation of this technique as method of choice for placement of nasoenteral feeding tubes .


The purpose of this study was to describe hospital and geographic variation in @-day risk of surgical complications and death among colorectal cancer ( CRC ) patients and the extent to which patient - , hospital - , and census-tract-level characteristics increased risk of these outcomes .


We included patients at least @years old with first primary stage I-III CRC from the @-@ National Cancer Institute 's Surveillance , Epidemiology , and End Results data linked with @-@ Medicare claims .


A multilevel , cross-classified logistic model was used to account for nesting of patients within hospitals and within residential census tracts .


Outcomes were risk of complications and death after a complication within @days of surgery .


Data were analyzed for @,@ patients undergoing surgery at @,@ hospitals and residing in @,@ census tracts ; @ % of patients developed complications , and of these @ % died .


Risk-adjusted variability in complications across hospitals and census tracts was similar .


Variability in mortality was larger than variability in complications , across hospitals and across census tracts .


Specific characteristics increased risk of complications ( e.g. , census-tract-poverty rate , emergency surgery , and being African-American ) .


No hospital characteristics increased complication risk .


Specific characteristics increased risk of death ( e.g. census-tract-poverty rate , being diagnosed with colon ( versus rectal ) cancer , and emergency surgery ) , while hospitals with at least @ beds showed reduced death risk .


Large , unexplained variations exist in mortality after surgical complications in CRC across hospitals and geographic areas .


The potential exists for quality improvement efforts targeted at the hospital and/or census-tract levels to prevent complications and augment hospitals ' ability to reduce mortality risk .


Clinicians require portable , valid , and cost-effective methods to monitor knee joint-position-sense ( JPS ) ability .


To examine the criterion-related validity of image-capture JPS measures against an isokinetic-dynamometer ( IKD ) procedure .


Random crossover design providing a comparison of knee JPS measures from image capture and IKD procedures .


@ healthy participants , @ female , age @ @ y , mass @ @ kg , height @ @ m , and @ male , @ @ y , mass @ @ kg , height @ @ m.


The dependent variables were absolute error scores ( AES ) provided by @ knee directions ( flexion and extension ) .


The independent variables were the method ( image capture and IKD ) .


There was no significant difference between clinical and IKD AES into knee-flexion data ( P = @ , r = @ ) .


There was a significant difference between clinical and IKD AES into knee-extension data ( P = @ , r = @ ) .


Analysis of photographic images to assess JPS measurements using knee flexion is valid against an IKD positioning method , but JPS measurements using knee extension may not be valid against IKD techniques .


However , photo-analysis measurements provided a lower error score using knee-extension data and thus may provide an optimal environment to produce maximal knee JPS acuity .


Therefore , clinicians do not need expensive equipment to collect representative JPS ability .


Lung volume reduction ( LVR ) techniques improve lung function in selected patients with emphysema , but the impact of LVR procedures on the asynchronous movement of different chest wall compartments , which is a feature of emphysema , is not known .


We used optoelectronic plethysmography to assess the effect of surgical and bronchoscopic LVR on chest wall asynchrony .


Twenty-six patients were assessed before and @ months after LVR ( surgical -LSB- n = @ -RSB- or bronchoscopic -LSB- n = @ -RSB- ) or a sham/unsuccessful bronchoscopic treatment ( control subjects , n = @ ) .


Chest wall volumes were divided into six compartments ( left and right of each of pulmonary ribcage -LSB- Vrc , p -RSB- , abdominal ribcage -LSB- Vrc , a -RSB- , and abdomen -LSB- Vab -RSB- ) and phase shift angles ( ) calculated for the asynchrony between Vrc , p and Vrc , a ( RC ) , and between Vrc , a and Vab ( DIA ) .


Participants had an FEV of @ @ % predicted and a residual volume of @ @ % predicted with significant chest wall asynchrony during quiet breathing at baseline ( RC , @ @ ; and DIA , -@ @ ) .


Between-group difference in the change in RC and DIA during quiet breathing following treatment was @ ( @ % CI , -@ to -@ ; P = @ ) and @ ( @ % CI , @ to @ ; P = @ ) toward @ ( representing perfect synchrony ) , respectively , favoring the LVR group .


Changes in RC and DIA were statistically significant on the treated but not the untreated sides .


Successful LVR significantly reduces chest wall asynchrony in patients with emphysema .


To assess the impact of passive and active promotional strategies on patient acceptance of medication therapy management ( MTM ) services , and to identify reasons for patient acceptance or refusal .


Four promotional approaches were developed to offer MTM services to eligible patients , including letters and bag stuffers ( `` passive '' approaches ) , and face-to-face offers and telephone calls ( `` active '' approaches ) .


Thirty pharmacies in a grocery store chain were randomized to one of the four approaches .


Patient acceptance rates were compared among the four groups , and between active and passive approaches using hierarchical logistic regression techniques .


Depending on their decision to accept or decline the service , patients were invited to take part in one of two brief telephone surveys .


No significant differences were identified among the four promotional methods or between active and passive methods in the analyses .


Patients ' most frequent reasons for accepting MTM services were potential cost savings , review of how the medications were working , the expert opinion of the pharmacist , and education about medications .


Patients ' most frequent reasons for declining MTM services were that the participant already felt comfortable with their medications and felt their pharmacist provides these services on a regular basis .


No significant difference was found among any of the four groups or between active or passive approaches .


Further research is warranted to identify strategies for improving patient engagement in MTM services .


To compare the effect on surgical indicators and functional outcome between preoperative skeletal traction and skin traction for adult femoral fracture and guide the choice of preoperative traction method of adult femoral fractures .


From February @ to September @ , @ patients aged greater than @-year-old with femoral fractures were treated and randomly divided into two groups according hospitalization order , the odd with skeletal traction of tibial tubercle ( group A ) and the even with skin traction ( group B ) .


In group A , there were @ males and @ females with an average age of ( @ ) years old , including @ cases with transverse fracture , @ cases with oblique fracture , @ cases with spiral fracture .


In group B , there @ males and @ females with an average age of ( @ ) years old , including @ cases with transverse fracture , @ cases with oblique fracture ,@ cases with spiral fracture .


The operative time , blood loss , the number and amount of blood transfusion , fracture healing time , hemoglobin , pain scores and functional scores between two groups were analyzed and compared .


Results : All patients were followed up , the follow-up time was ( @ ) months in group A , ( @ ) months in groupB .


In group A , the operation time was ( @ ) min and the intraoperative blood loss was ( @ ) ml and the postoperative blood transfusion was @ cases and the blood transfusion was ( @ ) ml and the average bone healing time was ( @ ) weeks .


In group B , the operation time was ( @ ) min and the intraoperative blood loss was ( @ @ ) ml and the blood transfusion was @ cases and the blood transfusion was ( @ ) ml and the average healing time was ( @ ) weeks .


These obseration indicators had no significant difference between two groups .


There was no significant difference between two groups in terms of Hemoglobin , the pain scores before and after traction , the femoral fractures efficacy score , knee function score and knee range .


Preoperative skeletal traction does not reduce surgery time , blood loss and pain and so on .


The bone healing time and limb functional outcomes were also not significantly improved .


To evaluate the benefit of aromatic therapy using menthol for decrease pain perception during amniocentesis .


A prospective randomized study was conducted to compare pain level between groups ofpregnant women who underwent amniocentesis with and without aromatic therapy using menthol .


Visual analogue scale ( VAS ) was usedfor pain assessment .


The participants were askedfor their anticipated pain and anxiety level and level ofpain before and immediately after the procedure .


Three hundred seventeen pregnant women were recruited into the present study , @ in the menthol group and @ in the non-menthol group .


Mean VAS score of the post-procedure pain and anxiety did not differ significantly between the two groups .


Mean VAS score of the anticipated pain influenced the mean VAS score of the pre-procedure anxiety and post-procedure pain and anxiety irrespective of the group .


Mean VAS score of the pre-procedure anxiety and post-procedure pain and anxiety increased about @ cm for each @ cm of increasing mean VAS score of anticipated pain .


Aromatic therapy using menthol was not significantly effective in reducing pain and anxiety during second trimester genetic amniocentesis .


Immune response and consequent inflammatory process which originate on ocular surface after a trauma are mediated by cytokines .


Photoablation of corneal stroma performed by excimer laser causes surgically induced trauma .


Interleukin-@ ( IL-@ ) is mostly known as a proinflammatory cytokine .


However , it also has regenerative and anti-inflammatory effects .


It is supposed that this cytokine is likely to play a significant role in the process of corneal wound healing response after photoablation of stroma carried out by laser in situ keratomileusis ( LASIK ) or photorefractive keratectomy ( PRK ) methods .


The aim of this study was to determine and compare the levels of IL-@ in tears before and after treatment with LASIK and PRK methods .


The study included @ shortsighted eyes up to -@ diopter sphere , i.e. @ samples of tears ( per three samples taken from each of the eyes ) , divided into two groups according to the kind of excimer laser intervention performed : the group @ -- eyes treated by LASIK method ( n = @ ) , and the group @ -- eyes treated by the PRK method ( n = @ ) .


The samples of tears were taken from each eye at the following time points : before excimer laser treatment ( @ h , the control group ) , @ h after the treatment ( @ h ) and @ h after the treatment ( @ h ) .


The patients did not use anti-inflammatory therapy @ h after the intervention .


Tear samples were collected using microsurgical sponge .


Level of IL-@ in tear fluid was determined by the flow cytometry method , applying a commercial test kit which allowed cytokine detection from a small sample volume .


Results .


The values of IL-@ were detectable in @ % of samples before LASIK treatment and in @ % of samples before PRK treatment .


One h after the treatment IL-@ was detectable in @ % of samples for the LASIK group and @ % of samples for the PRK group , and @ h after the treatment it was detectable in @ % of samples for the LASIK group and in @ % of samples for the PRK group .


When we analyzed the dynamics of IL@ production in particular groups , we noticed that both in the LASIK and PRK group the number of samples with increased values of IL-@ after @ h , and after @ h , was con - siderably larger than the number of samples with decreased values of IL-@ after the intervention .


Analyzing the dynamics of IL-@ concentration changes in the @ h samples vs. @ h samples there was a statistically significant increase in the number of samples with IL-@ concentration decline in the LASIK group , while at the same time no considerable changes occurred in the PRK group .


Comparing average IL-@ values between the two treatment groups in all tear samples at @ h , @ h and @ h after intervention a significantly higher level in the PRK group @ h after procedure ( p = @ ) was detected .


IL-@ level in tears increases @ h and @ h after LASIK and PRK treatments .


This increment is significantly larger @ h after the treatment with the PRK method than with the LASIK method .


Changes of IL-@ production levels in tears after excimer laser treatment indicate that this cytokine takes part in the corneal recovery process after stromal photoablation .


Although half of all patients with heart failure ( HF ) have a normal or near-normal ejection fraction and their prognosis differs little from that of patients with a reduced ejection fraction , the pathophysiology of HF with preserved ejection fraction ( HF-PEF ) is still poorly understood , and its management poorly supported by clinical trials .


Sodium and fluid restriction is the most common self-care measure prescribed to HF patients for management of congestive episodes .


However , its role in the treatment of HF-PEF remains unclear .


This trial seeks to compare the effects of a sodium - and fluid-restricted diet versus an unrestricted diet on weight loss , neurohormonal activation , and clinical stability in patients admitted for decompensated HF-PEF .


This is a randomized , parallel trial with blinded outcome assessment .


The sample will include adult patients ( aged @years ) with a diagnosis of HF-PEF admitted for HF decompensation .


The patients will be randomized to receive a diet with sodium and fluid intake restricted to @ g/day and @mL/day respectively ( intervention group ) or an unrestricted diet , with @g/day sodium and unlimited fluid intake ( control group ) , and followed for @days or until hospital discharge .


The primary outcome shall consist of weight loss at @days or discharge .


The secondary outcome includes assessment of clinical stability , neurohormonal activation , daily perception of thirst and readmission rate at @days .


Assessment of the effects of sodium and fluid restriction on neurohormonal activation and clinical course of HF-PEF can promote a deeper understanding of the pathophysiology and progression of this complex syndrome .


New in-vehicle technologies often outpace the scientific support for their value .


In lieu of valid and consistent scientific support , common wisdom is used , as in the assumption that enhanced roadway delineation improves driving safety .


To evaluate the effects of a Visibility Enhancement System that selectively improves lane markers ' visibility on driving safety .


A simulation experiment assessed the effects of an in-car lane Visibility Enhancement System ( VES ) that highlights the edges of the road ahead on driver 's behavior and overall safety , under normal and reduced visibility conditions .


Thirty drivers drove in a fix-based simulator through a winding rural road , while attempting to avoid un-enhanced and unexpected obstacles that appeared on the driving lane from time to time .


The simulated VES highlighted the road edges up to a distance of @ m with two alternative configurations : two continuous red lines or a series of red crosses .


The effects of the two VES configurations on performance were measured during night and fog driving .


Performance measures included speed , lane keeping behavior , eye scanning pattern , reaction time ( RT ) and collisions with the un-enhanced unexpected obstacles .


Subjective measures included confidence and stress .


With the VES , drivers were more confident , less stressed , and drove faster , but had almost twice as many collisions with the unexpected obstacles .


Also , steering/braking RT to the obstacles was longer with the VES than without it by nearly @ msec .


The results are consistent with Lebowitz 's theory ( @ ) .


While the VES enhanced spatial orientation , it fooled the drivers into assuming that the visibility of obstacles on the road was also improved , and thus actually reduced safety .


When visibility is an issue in nighttime crashes , the site-specific crashes should be investigated , in cases of collision with objects-on-the-road , improved delineation should be ruled out .


Pregabalin may reduce postoperative pain and opioid use .


Higher doses may be more effective , but may cause sedation and confusion .


This prospective , randomized , blinded , placebo-controlled study tested the hypothesis that pregabalin reduces pain at @ weeks after total knee arthroplasty , but increases drowsiness and confusion .


Patients ( @ per group ) received capsules containing pregabalin ( @ , @ , @ , or @ mg ) ; two capsules before surgery , one capsule twice a day until postoperative day ( POD ) @ , one on POD@ , and one on POD@ .


Multimodal analgesia included femoral nerve block , epidural analgesia , oxycodone-paracetamol , and meloxicam .


The primary outcome was pain with flexion ( POD@ ) .


Pregabalin did not reduce pain at rest , with ambulation , or with flexion at @ weeks ( P = @ , @ , and @ , respectively ) .


Pregabalin increased POD@ drowsiness ( @ , @ , @ , and @ % in the @ , @ , @ , and @ mg arms , respectively ; P = @ ) , but did not increase confusion ( @ , @ , @ , and @ % , respectively ; P = @ ) .


Pregabalin had no effect on acute or chronic pain , opioid consumption , or analgesic side-effects .


Pregabalin reduced POD@ patient satisfaction -LSB- @-@ scale , median ( first quartile , third quartile ) : @ ( @ , @ ) , @ ( @ , @ ) , @ ( @ , @ ) , and @ ( @ , @ ) , respectively ; P = @ ) .


Protocol compliance was @ % by POD@ ( @ , @ , @ , and @ % compliance , respectively ) , with no effect of dose on compliance .


Per-protocol analysis of compliant patients showed no effect of pregabalin on pain scores .


Pregabalin had no beneficial effects , but increased sedation and decreased patient satisfaction .


This study does not support routine perioperative pregabalin for total knee arthroplasty patients .


Obstructive sleep apnea ( OSA ) and hypertension are well-known cardiovascular risk factors .


Their control could reduce the burden of heart disease across populations .


Several drugs are used to control hypertension , but the only consistently effective treatment of OSA is continuous positive airway pressure .


The identification of a drug capable of improving OSA and hypertension simultaneously would provide a novel approach in the treatment of both diseases .


This is a randomized double-blind clinical trial , comparing the use of chlorthalidone with amiloride versus amlodipine as a first drug option in patients older than @ years of age with stage I hypertension ( @ to @/@ to @mmHg ) and moderate OSA ( @ to @ apneas/hour of sleep ) .


The primary outcomes are the variation of the number of apneas per hour and blood pressure measured by ambulatory blood pressure monitoring .


The secondary outcomes are adverse events , somnolence scale ( Epworth ) , ventilatory parameters and C reactive protein levels .


The follow-up will last @ weeks .


There will be @ participants per group .


The project has been approved by the ethics committee of our institution .


The role of fluid retention in OSA has been known for several decades .


The use of diuretics are well established in treating hypertension but have never been appropriately tested for sleep apnea .


As well as testing the efficacy of these drugs , this study will help to understand the mechanisms that link hypertension and sleep apnea and their treatment .


The beneficial effect of rosuvastatin against percutaneous coronary intervention ( PCI ) related procedural myocardial injury has been determined mostly in patients with acute coronary syndromes ( ACS ) .


However , the detailed therapeutic mechanism has not been well studied .


Patients with ACS receiving PCI ( n = @ ) were randomized to control group ( placebo treatment ) or to rosuvastatin group ( @ mg @ h before PCI , and a further @ mg @ h preprocedure dose ) .


Levels of INF - , TNF - , IL-@ , miR-@ / SHIP-@ , and CD@ ( + ) FoxP@ ( + ) Treg in peripheral blood were detected before PCI and @ h after PCI .


Clinical data of these patients were also collected in this prospective study .


Compared with placebo , rosuvastatin treatment significantly reduced the incidence of periprocedural myocardial infarction ( PMI ) and levels of cardiac troponin I ( cTnI ) associated with decreased relative expression of serum miR-@ , levels of inflammatory cytokines ( INF - , TNF - , and IL-@ ) , increased SHIP-@ expression and CD@ ( + ) FoxP@ ( + ) Treg percentage values ( P < @ ) .


In addition , patients with rosuvastatin pretreatment also reduced incidence of @ days major adverse cardiac events ( MACE ) compared to the patients with placebo treatment ( @ patients vs. @ patients , P = @ ) .


Our study suggests that high loading dose rosuvastatin pretreatment may reduce the incidence of cardiovascular events and levels of inflammatory markers in patients with ACS receiving PCI , which may be explained at least in part , by mechanism involving suppression of miR-@ / SHIP-@ signaling pathway .


Adherence to insulin therapy can be threatened by pain and needle fear .


This cross-over randomized non-inferiority trial evaluated a new Pic Insupen @G@mm needle vs. a @G@mm needle in terms of metabolic control , safety and acceptability in patients with diabetes treated with insulin .


We used a centralized , permuted block randomization , stratified by center and maximum insulin dose per single injection .


Subjects used the two needles in two @ week treatment periods .


The primary endpoint was the absolute percentage variation of the blood fructosamine between the two treatments ( % | Fru | ) .


Additional endpoints were : glycemic variability , total insulin doses , body weight , severe hypoglycemic episodes , leakage at injection sites and pain measured by visual analogue scale .


Equivalent glycemic control was defined a priori as % | Fru | ( including @ % CI ) within @ % .


Of @ subjects randomized , @ completed the study ( median age @ -LSB- IR @-@ @ -RSB- , median BMI @ Kg/m ( @ ) -LSB- IR @-@ @ -RSB- , median duration of insulin therapy -LSB- in months -RSB- @ ( IR @-@ @ ) , median baseline HbA@c @ % -LSB- IR @-@ @ -RSB- ) .


The % | Fru | was @ % ( @ % CI @-@ @ ) , meeting the non-inferiority criterion .


The fasting blood glucose standard deviation was @ ( mean @ ) with the @G needle and @ ( mean @ ) with the @G needle ( p = @ ) .


Insulin daily dose and patients ' weight did not show any statistically significant variation .


We observed @ episodes of symptomatic hypoglycemia with the @G needle and @ with the @G needle .


One episode of severe hypoglycemia was documented in the latter group .


As for insulin leakage we observed @ episodes per @ patient-days with the @G needle and @ episodes per @ patient-days with the @G needle ( p = @ ) .


Patients reported less pain with the @G@mm needle ( p = @ ) .


Study sample was mainly composed of adults with type @ diabetes and study was not blinded .


The @G needle is not inferior to the @G needle in terms of efficacy and safety , with reduced pain and no difference in insulin leakage .


Pregnancy and the postpartum period present important intervention opportunities .


Counseling can leverage the motivation women have during this time to change behaviors that may negatively affect their health and the heath of their infants .


Pregnant women attending an antenatal clinic in South Africa were randomly allocated to treatment ( n = @ ) and control arms ( n = @ ) .


Treatment arm participants received enhanced HIV pre - and post-test counseling , legal support and access to support groups at baseline , which occurred at the first antenatal visit , and then six and ten weeks postpartum .


Control arm participants received standard HIV testing and counseling ( HTC ) and two postpartum attention control sessions .


Outcomes were incidence of sexually transmitted infection ( STI ) by @ weeks postpartum and past @-day inconsistent condom use at @ weeks and @ months postpartum .


There were no intervention effects on incident STIs for either HIV-negative ( adjusted risk ratio ( aRR ) @ , @ % CI @-@ @ ) or HIV-positive participants ( aRR @ , @ % CI @-@ @ ) .


The intervention was associated with a @ % decrease in risk of past @-day inconsistent condom use at nine-months among HIV-negative women ( aRR @,@ % CI @-@ @ ) , but did not affect inconsistent condom use among HIV-positive women ( aRR@ @ ; @ % CI @-@ @ ) .


An enhanced counseling intervention during pregnancy and the postpartum period can lead to reductions in inconsistent condom use among HIV-negative women .


Results underscore the importance of the counseling that accompanies HIV HTC .


More work is needed to understand how to promote and sustain risk reduction among HIV-positive women .


Simeprevir is an oral , once-daily inhibitor of hepatitis c virus ( HCV ) protease NS@/@A .


We investigated the safety and efficacy of simeprevir with peg-interferon -@ a and ribavirin ( PR ) in a randomized , double-blind , placebo-controlled , phase @ trial of patients with HCV genotype @ infection who relapsed after previous interferon-based therapy .


Patients were assigned randomly ( @:@ ) to groups given simeprevir ( @ mg , once daily ) and PR ( n = @ ) or placebo and PR ( n = @ ) for @ weeks .


Patients then were given PR alone for @ or @ weeks ( simeprevir group , based on response-guided therapy criteria ) or @ weeks ( placebo group ) .


Simeprevir and PR was significantly superior to placebo and PR ; rates of sustained virologic response @ weeks after planned end of treatment ( SVR@ ) were @ % vs @ % , respectively ( @ % difference ; @ % confidence interval , @-@ @ ; P < @ ) .


Among patients given simeprevir , @ % met the response-guided therapy criteria and were eligible to complete PR at week @ ; of these , @ % achieved SVR@ .


HCV RNA was undetectable at week @ in @ % of patients given simeprevir and @ % given placebo .


On-treatment failure and relapse rates were lower among patients given simeprevir and PR than those given placebo and PR ( @ % vs @ % , and @ % vs @ % , respectively ) .


Patients given simeprevir did not have adverse events beyond those that occurred in patients given PR alone .


Most adverse events were grades @/@ ; the prevalence of anemia and rash was similar in both groups .


Patients in both groups reported similar severity of fatigue and functional impairments during the study , but duration was reduced among patients given simeprevir .


In a phase @ trial of patients who had relapsed after interferon-based therapy , the addition of simeprevir to PR was generally well tolerated , with an SVR@ rate of @ % .


Most patients ( @ % ) receiving simeprevir were able to shorten therapy to @ weeks .


ClinicalTrials.gov number : NCT@ .


Due to physical characteristics , ions like protons or carbon ions can administer the dose to the target volume more efficiently than photons since the dose can be lowered at the surrounding normal tissue .


Radiation biological considerations are based on the assumption that the / value for prostate cancer cells is @ Gy , so that a biologically more effective dose could be administered due to hypofractionation without increasing risks of late effects of bladder ( / = @ ) and rectum ( / = @ ) .


The IPI study is a prospective randomized phase II study exploring the safety and feasibility of primary hypofractionated irradiation of the prostate with protons and carbon ions in a raster scan technique .


The study is designed to enroll @ patients with localized prostate cancer .


Primary aim is the assessment of the safety and feasibility of the study treatment on the basis of incidence grade III and IV NCI-CTC-AE ( v. @ ) toxicity and/or the dropout of the patient from the planned therapy due to any reason .


Secondary endpoints are PSA-progression free survival ( PSA-PFS ) , overall survival ( OS ) and quality-of-life ( QoL ) .


This pilot study aims at the evaluation of the safety and feasibility of hypofractionated irradiation of the prostate with protons and carbon ions in prostate cancer patients in an active beam technique .


Additionally , the safety results will be compared with Japanese results recently published for carbon ion irradiation .


Due to the missing data of protons in this hypofractionated scheme , an in depth evaluation of the toxicity will be created to gain basic data for a following comparison study with carbon ion irradiation .


High rates of ischemic stroke and poor adherence to secondary prevention measures are observed in the Chinese population .


We used a national , multicenter , cluster-randomized controlled trial in which @ hospitals were randomized to either a structured care program group ( n = @ ) or a usual care group ( n = @ ) .


The structured care program consisted of a specialist-administered , guideline-recommended pharmaceutical treatment and a lifestyle modification algorithm associated with written and Internet-accessed educational material for patients for the secondary prevention of ischemic stroke .


The primary efficacy outcome was the proportion of patients who adhered to the recommended measures at @-month postdischarge .


This trial is registered with ClinicalTrial.gov ( NCT@ ) .


At @ months , @ ( @ % ) patients in the Standard Medical Management in Secondary Prevention of Ischemic Stroke in China ( SMART ) group and @ ( @ % ) patients in the usual care group had completed the @-month follow-up ( P = @ ) .


Compared with the usual care group , those in the SMART group showed higher adherence to statins ( @ % versus @ % ; P = @ ) but no difference in adherence to antiplatelet ( @ % versus @ % ; P = @ ) , antihypertensive ( @ % versus @ % ; P = @ ) , or diabetes mellitus drugs ( @ % versus @ % ; P = @ ) .


No significant difference in the composite end point ( new-onset ischemic stroke , hemorrhagic stroke , acute coronary syndrome , and all-cause death ) was observed ( @ % versus @ % ; P = @ ) .


The implementation of a program to improve adherence to secondary ischemic stroke prevention efforts in China is feasible , but these programs had only a limited impact on adherence and no impact on @-year outcomes .


Further development of a structured program to reduce vascular events after stroke is needed .


Clinical Trial Registration-URL : http://www.clinicaltrials.gov .


Unique identifier : NCT@ .


To compare the effect of transumbilical single-site single-port with that of transumbilical single-site double-port laparoscopic varicocelectomy in the treatment of varicocele in adolescents .


We randomly assigned @ varicocele patients aged @ - @ years to two groups of equal number to receive transumbilical single-site single-port and single-site double-port laparoscopic varicocelectomy , respectively .


We compared the operation time , postoperative hospital stay , incisional pain , complications and satisfaction with the abdominal cosmetic outcomes between the two groups .


All the operations were successfully performed .


The double-port group showed a significantly higher score on the Visual Analogue Scale than the single-port group ( @ + / - @ vs @ + / - @ , t = -@ , P < @ ) , but there were no significant differences between the two groups in the operation time ( -LSB- @ + / - @ -RSB- vs -LSB- @ + / - @ -RSB- min , t = @ , P = @ ) , postoperative hospital stay ( -LSB- @ + / - @ -RSB- vs -LSB- @ + / - @ -RSB- d , t = -@ , P = @ ) , complications ( @ vs @ ) and scores on the satisfaction with abdominal cosmetic outcomes ( @ + / - @ vs @ + / - @ , t = @ , P = @ ) .


No recurrence , umbilical hernia , hydrocele and orchiatrophy were found in the two groups of patients at @ months after operation , and no visible scar was observed on the abdominal surface .


With strict surgical indications , single-site single-port and single-site double-port laparoscopic varicocelectomies have similar clinical effects in the treatment of varicocele , which leave no scar on the abdominal surface .


Single-site double-port laparoscopy needs no special instruments and therefore is worthier of wide clinical application .


Clinical decision rules ( CDRs ) can be an effective tool for knowledge translation in emergency medicine , but their implementation is often a challenge .


This study examined whether the Theory of Planned Behaviour ( TPB ) could help explain the inconsistent results between the successful Canadian C-Spine Rule ( CCR ) implementation study and unsuccessful Canadian CT Head Rule ( CCHR ) implementation study .


Both rules are aimed at improving the accuracy and efficiency of emergency department radiography use in clinical contexts that exhibit enormous inefficiency at the present time .


The rules were prospectively derived and validated using the same methodology demonstrating high sensitivity and reliability .


The rules subsequently underwent parallel implementations at @ Canadian hospitals , yet only the CCR was observed to significantly reduce radiography ordering rates , while the CCHR failed to have any significant impact at all .


The drastically different results are unlikely to be the result of differences in implementation strategies or the decision rules .


Physicians at the @ participating Canadian hospitals were randomized to CCR or CCHR TPB surveys that were administered during the baseline phases of the implementation studies , before any intervention had taken place .


The collected baseline survey data were linked to concurrent baseline physician and patient-specific imaging data , and subsequently analyzed using mixed effects linear and logistic models .


A total of @ of the @ eligible physicians randomized to a TPB survey completed their assigned baseline survey ( CCR : @ of @ ; CCHR : @ of @ ) .


Attitudes were significantly associated with intention in both settings ( CCR : = @ ; CCHR : = @ ) , as were subjective norms ( CCR : = @ ; CCHR : = @ ) .


Intention was significantly associated with actual image ordering for CCR ( OR = @ ) , but not CCHR .


The TPB can be used to better understand processes underlying use of CDRs .


TPB constructs were significantly associated with intention to perform both imaging behaviours , but intention was only associated with actual behaviour for CCR , suggesting that constructs outside of the TPB framework may need to be considered when seeking to understand use of CDRs .


To compare the efficacy difference of analgesia and detumescence on ankle sprain among acupuncture at Xiaojie point combined with tendon regulation manipulation , acupuncture at Xiaojie point and tendon regulation manipulation .


Sixty cases of ankle sprain were randomized into a combined therapy group , a Xiaojie point group and a tendon-regulation manipulation group , @ cases in each one .


The combined therapy of acupuncture at Xiaojie point and tendon regulation manipulation , the acupuncture at Xiaojie point and the simple application of tendon-regulation manipulation were applied respectively in the three groups , once a day , @ treatments were required .


The symptom score such as pain , ecchymosis , swelling and motor dysfunction and the total score were observed before and after treatment in the three groups .


The different values of pain and swelling scores were compared before and after treatment in the three groups .


The efficacy was compared among the groups .


The total effective rate was @ % ( @/@ ) in each group .


But the curative rate was @ % ( @/@ ) in the combined group , @ % ( @/@ ) in the Xiaojie point tion manipulation group .


After treatment , the symptom scores of pain , ecchymosis , swelling and motor dysfunction and the total score were all improved as compared with those before treatment in the three groups ( P < @ , P < @ ) .


The pain score in either the combined therapy group or Xiaojie point group was lower than that in the tendon-regulation manipulation group after treatment ( @ - / + @ , @ + / - @ vs @ + / - @ , both P < @ ) .


Swelling score in the Xiaojie point group was different significantly from that in the tendon-regulation manipulation @ vs @ vs. @ +@ , P < @ ) .


The different value of pain score in either the combined therapy group or Xiaojie point group was higher than that in the tendon-regulation manipulation group before group after treatment ( @ bined therapy group or Xiaojie point group was higher than that in the tendon-regulation manipulation group before and after treatment ( @ + / - @ , @ + / - @ vs @ + / - @ , both P < @ ) .


The different value of swelling score in the tendon-regulation manipulation group was higher than that in the Xiaojie point group before and after treatment ( @ + / - @ vs @ + / - @ , P < @ ) .


Acupuncture at Xiaojie point combined with tendon-regulation manipulation achieve an apparent effect of analgesia and detumescence on ankle sprain .


To explore the clinical efficacy and safety of the early use of urokinase in the prevention and treatment on tunneled hemodialysis catheter related fibrin sheaths .


Thirty-eight hemodialysis patients with tunneled central venous catheter and good catheter function were randomly divided into experimental group and control group .


Urokinase was given after @ days of indwelling catheter in the experimental group and after the onset of catheter dysfunction in the control group .


The catheter function , mean blood flow and venous pressure of dialysis , coagulation , and side effects in the two groups were observed for @ months .


The rates of catheter dysfunction on the arterial side were @ % and @ % in the experimental group and control group , respectively ( P < @ ) , with catheter dysfunction rates on the vein side of @ % and @ % , respectively ( P < @ ) .


Catheter dysfunction occurred for the first time at @ @ days in the experimental group , and at @ @ days in the control group ( P < @ ) .


The mean blood flow showed no significant difference between the two groups at @ month after tube insertion ( P > @ ) , but was higher in the experimental group at @ and @ months after the tube insertion ( P < @ ) .


The mean venous pressure in two groups was similar @ and @ months after tube insertion ( P > @ ) , but was significantly lower in the experimental group at @ months ( P < @ ) .


Compared with control group , the experimental group showed significantly prolonged prothrombin time ( P < @ ) but similar rest coagulation parameters .


No serious drug-related side effects occurred in these two groups .


Early use of urokinase is safe and effective for prevention and treatment of tunneled hemodialysis catheter-related fibrin sheaths with minimal side effects .


Therapeutic ultrasound and transcutaneous electrical nerve stimulation ( TENS ) have been described as being effective in the treatment of spasticity .


No previous study compared these physical modalities with a first-line treatment for spasticity , such as botulinum toxin type A.


To compare the effects of therapeutic ultrasound and TENS with botulinum toxin type A on spasticity after stroke .


Thirty patients with chronic stroke and spastic equinus were randomly assigned to @ groups : @ group received therapeutic ultrasound to the affected leg calf muscles , @ group underwent TENS to the tibial nerve of the affected leg , and @ group was injected with onabotulinum toxin A in the spastic gastrocnemius .


All patients were evaluated immediately before treatment and @ , @ , and @ days after the first clinical evaluation .


The following outcome measures were considered : ankle passive dorsiflexion range of motion and the modified Ashworth scale .


Patients injected with botulinum toxin type A had significantly better ankle passive range of motion than those treated with physical modalities at all posttreatment evaluations .


At second and third posttreatment evaluations , the modified Ashworth scale indicated significantly greater improvement in patients injected with botulinum toxin type A than in those treated with physical modalities .


No difference was found between groups treated with physical modalities .


Our findings support the hypothesis that botulinum toxin type A is more effective than therapeutic ultrasound and TENS for treating focal spasticity in patients with chronic stroke .


GOG @ was a practice-changing randomised phase @ trial that concluded that chemotherapy plus bevacizumab for advanced cervical cancer significantly improves overall and progression-free survival , and the proportion of patients achieving an overall objective response , compared with chemotherapy alone .


In this study , we aimed to analyse patient-reported outcomes in GOG @ .


Eligible adult participants ( aged @ years ) had primary stage IVB or recurrent or persistent carcinoma of the cervix with measurable disease and GOG performance status of @-@ .


Participants were randomly assigned by web-based permuted block randomisation ( block size @ ) in a @:@:@:@ ratio to the four treatment groups : cisplatin ( @ mg/m ( @ ) intravenously on day @ or @ of the treatment cycle ) and paclitaxel ( @ mg/m ( @ ) intravenously over @ h or @ mg/m ( @ ) intravenously over @ h on day @ ) , with or without bevacizumab ( @ mg/kg intravenously on day @ or @ ) , or paclitaxel ( @ mg/m ( @ ) over @ h on day @ ) and topotecan ( @ mg/m ( @ ) for @ min on days @-@ ) with or without bevacizumab ( @ mg/kg intravenously on day @ ) .


Treatment assignment was concealed at randomisation ( everyone was masked to treatment assignment , achieved by the use of a computer encrypted numbering system at the National Cancer Institute ) and became open-label when each patient was registered to the trial .


Treatment cycles were repeated every @ days until disease progression or unacceptable toxicity , whichever occurred first .


The coprimary endpoints of the trial were overall survival and safety ; the primary quality-of-life endpoint was the score on the Functional Assessment of Cancer Therapy-Cervix Trial Outcome Index ( FACT-Cx TOI ) .


For our analysis of patient-reported outcomes , participants were assessed before treatment cycles @ , @ , and @ , and at @ and @ months after the start of cycle @ , with the FACT-Cx TOI , items from the FACT-GOG-Neurotoxicity subscale , and a worst pain item from the Brief Pain Inventory .


All patients who completed baseline quality-of-life assessments and at least one further follow-up assessment were evaluable for quality-of-life outcomes .


This study is registered with ClinicalTrials.gov , number NCT@ .


Between April @ , @ , and Jan @ , @ , a total of @ patients were enrolled in the trial , of whom @ completed baseline quality-of-life assessment and at least one further assessment and were therefore evaluable for quality-of-life outcomes .


In these patients , patient-reported outcome completion declined from @ ( @ % ) of @ ( at baseline ) to @ ( @ % ) of @ ( @ months post-cycle @ ) , but completion rates did not differ significantly between treatment regimens ( p = @ ) .


The baseline FACT-Cx TOI scores did not differ significantly between patients who received bevacizumab versus those who did not ( p = @ ) .


Compared with patients who received chemotherapy alone , patients who received chemotherapy plus bevacizumab reported FACT-Cx TOI scores that were an average of @ points lower ( @ % CI -@ to @ ; p = @ ) .


Improvements in overall survival and progression-free survival attributed to the incorporation of bevacizumab into the treatment of advanced cervical cancer were not accompanied by any significant deterioration in health-related quality of life .


Patients responding to anti-angiogenesis therapy who maintain an acceptable quality of life could be suitable at progression for treatment with other novel therapies that might confer additional benefit .


Multimorbid patients frequently receive complex medication regimens and are at higher risk for adverse drug reactions and hospitalisations .


Managing patients with polypharmacy is demanding , because it requires coordination of multiple prescribers and intensive monitoring .


Three evidence-based recommendations addressing polypharmacy in primary care are structured medication counselling , use of medication lists and medication reviews to avoid potentially inappropriate medication ( PIM ) .


Although promising to improve patient outcomes , these recommendations are not well implemented in German routine care .


Implementation of guidelines is often hindered by specific `` determinants of change '' .


`` Tailored '' interventions are designed to specifically address previously identified determinants .


This study examines a tailored intervention to implement the aforementioned recommendations into German primary care practices .


This study is part of the European Tailored Interventions for Chronic Diseases project , which aims at contributing knowledge about the methods used for tailoring .


The study is designed as a cluster randomized controlled trial with primary care practices of general practitioners ( GPs ) who are organized in quality circles .


Quality circles will be the unit of randomization with a @:@ ratio .


Follow-up time is @ months .


GPs and healthcare assistants in the intervention group will receive training on medication management .


Each GP will create a tailored concept of how to implement the three recommendations into his/her practice .


Evidence-based checklists for medication counselling and medication reviews will be provided for physicians .


A tablet PC with an interactive educational tool and information leaflets will be provided for use by patients to inform about the necessity of continuous medication management .


Control practices will not receive special training and will provide care as usual .


Primary outcome is the degree of implementation of the three recommendations , which will be measured using a prespecified set of indicators .


Additionally , the PIM prescription rate , patient activation , patients ' beliefs about medicine , medication adherence and patients ' social support will be measured .


This study will contribute knowledge about the feasibility of implementing recommendations for managing patients with polypharmacy in primary care practices .


Additionally , this study will contribute knowledge about methods for tailoring of implementation interventions .


This trial evaluated the efficacy of acetaminophen in reducing oxidative injury , as measured by plasma F@-isoprostanes , in adult patients with severe sepsis and detectable plasma cell-free hemoglobin .


Single-center , randomized , double-blind , placebo-controlled phase II trial .


Medical ICU in a tertiary , academic medical center .


Critically ill patients @ years old or older with severe sepsis and detectable plasma cell-free hemoglobin .


Patients were randomized @:@ to enteral acetaminophen @ g every @ hours for @ days ( n = @ ) or placebo ( n = @ ) with the same dosing schedule and duration .


F@-Isoprostanes on study day @ , the primary outcome , did not differ between acetaminophen ( @ pg/mL ; interquartile range , @-@ ) and placebo ( @ pg/mL ; interquartile range , @-@ ; p = @ ) .


However , F@-isoprostanes were significantly reduced on study day @ in the acetaminophen group ( @ pg/mL ; interquartile range , @-@ ) when compared with placebo ( @ pg/mL ; interquartile range , @-@ ; p = @ ) .


Creatinine on study day @ , a secondary outcome , was significantly lower in the acetaminophen group ( @ mg/dL ; interquartile range , @-@ @ ) when compared with that in the placebo ( @ mg/dL ; interquartile range , @-@ @ ; p = @ ) .


There was no statistically significant difference in hospital mortality ( acetaminophen @ % vs placebo @ % ; p = @ ) or adverse events ( aspartate aminotransferase or alanine aminotransferase > @ ; acetaminophen @ % vs placebo @ % ; p = @ ) .


In adults with severe sepsis and detectable plasma cell-free hemoglobin , treatment with acetaminophen within @ hours of ICU admission may reduce oxidative injury and improve renal function .


Additional study is needed to confirm these findings and determine the effect of acetaminophen on patient-centered outcomes .


To explore knowledge and use of female condoms in China , and to compare four modes of failure between the Phoenurse female condom ( PFC ) and the second-generation Femidom female condom ( FC@ ) .


In a randomized , crossover trial , sexually active women aged @-@years who attended a family planning service in Qingdao , China , were recruited between April and October , @ .


A computer-generated randomized sequence was used to assign participants ( @:@ ) to group A ( used @ PFCs followed by @ FC@s ) or group B ( used @ FC@s followed by @ PFCs ) .


Study investigators and participants were masked to allocation .


Participants completed questionnaires at baseline and after using the two types of FCs .


They also kept coital logs .


At baseline , @ ( @ % ) of @ participants understood female condoms , but only @ ( @ % ) had ever used one .


Total failure rates were @ % ( @/@ @ ) and @ % ( @/@ @ ) for PFC and FC@ , respectively ( P < @ ) .


Slippage was the most common form of failure , affecting @ % of PFC uses and @ % of FC@ uses .


Breakage , misdirection , and slippage were significantly more common with the PFC than with the FC@ ( P@ @ ) .


Understanding of female condoms is poor in China .


Failure is more common with the PFC than with the FC@ .


Increased circulating tumor cells ( CTCs ; five or more CTCs per @ mL of whole blood ) are associated with poor prognosis in metastatic breast cancer ( MBC ) .


A randomized trial of patients with persistent increase in CTCs tested whether changing chemotherapy after one cycle of first-line chemotherapy would improve the primary outcome of overall survival ( OS ) .


Patients with MBC who did not have increased CTCs at baseline remained on initial therapy until progression ( arm A ) .


Patients with initially increased CTCs that decreased after @ days of therapy remained on initial therapy ( arm B ) .


Patients with persistently increased CTCs after @ days of therapy were randomly assigned to continue initial therapy ( arm C@ ) or change to an alternative chemotherapy ( arm C@ ) .


Of @ eligible and evaluable patients , @ ( @ % ) did not have increased CTCs ( arm A ) .


Of those with initially increased CTCs , @ ( @ % ) were not retested , @ were assigned to arm B , and @ were randomly assigned to arm C@ or C@ .


No difference in median OS was observed between arm C@ and C@ ( @ and @ months , respectively ; P = @ ) .


CTCs were strongly prognostic .


Median OS for arms A , B , and C ( C@ and C@ combined ) were @ months , @ months , and @ months , respectively ( P < @ ) .


This study confirms the prognostic significance of CTCs in patients with MBC receiving first-line chemotherapy .


For patients with persistently increased CTCs after @ days of first-line chemotherapy , early switching to an alternate cytotoxic therapy was not effective in prolonging OS .


For this population , there is a need for more effective treatment than standard chemotherapy .


Oral contraceptives ( OC ) are effective for birth control and have good cycle control and tolerability .


However , the hormonal components could modify mood and libido .


The aim of this study is to evaluate the genital vascular effects and sexual behavior of an OC containing @ g ethinyl estradiol and @ mg drospirenone in comparison with a flexible combined contraceptive vaginal ring .


Forty women underwent a sonographic assessment of the clitoral anatomy and vascularization and were administered the McCoy Female Sexuality Questionnaire ( MFSQ ) and the Beck 's Depression Inventory questionnaire ( BDI ) .


Estradiol , androstenedione , testosterone , and SHBG were assayed .


Free Androgen Index ( FAI ) and Free Estrogen Index ( FEI ) were calculated .


The patients were randomly submitted to OC ( group I ; n = @ ) or vaginal ring ( group II ; n = @ ) .


Ultrasonographic clitoral volume , pulsatility index ( PI ) of dorsal clitoral arteries , MFSQ , BDI , and hormonal and biochemical assays were analyzed .


After therapy , the testosterone levels were reduced in both groups , whereas estradiol decreased only in group I women .


The SHBG increased in all the subjects , and both FAI and FEI decreased .


The clitoral volume decreased in all the women .


The PI of the dorsal clitoral artery increased only in patients on OC .


The hormonal contraception was associated , in both studied groups , with a significant decrease of the two-factor Italian MFSQ score , which was more marked in OC users .


In group I subjects , there was a reduction of the number of intercourse/week and a reduction of orgasm frequency during intercourse .


The pain during intercourse worsened after OC use .


The vaginal ring users reported a vaginal wetness .


Six-month treatment with hormonal contraception is associated with a diminished MFSQ score .


However , the frequency of sexual intercourse and orgasm was reduced only by the use of OC .


The OC use was associated with increased pain during intercourse .


In @-@ , we did a randomised controlled trial in southern Nepal , and reported that children born to mothers taking multiple micronutrient supplements during pregnancy had a mean birthweight @ g greater than children born to mothers taking iron and folic acid supplements .


Children born to mothers in the study group were a mean @ g heavier at @ years of age and their systolic blood pressure was a mean @ mm Hg lower than children born to mothers in the control group .


We aimed to follow up the same children to mid-childhood ( age @ years ) to investigate whether these differences would be sustained .


For this follow-up study , we identified children from the original trial and measured anthropometry , body composition with bioelectrical impedance ( with population-specific isotope calibration ) , blood pressure , and renal dimensions by ultrasound .


We documented socioeconomic status , household food security , and air pollution .


Main outcomes of the follow-up at @ years were Z scores for weight-for-age , height-for-age , and body-mass index ( BMI ) - for-age according to WHO Child Growth Standards for children aged @-@ years , and blood pressure .


This study is registered with the International Standard Randomised Controlled Trial register , number ISRCTN@ .


Between Sept @ , @ , and Dec @ , @ , we assessed @ children ( @ in the control group and @ in the intervention group ) .


Unadjusted differences ( intervention minus control ) in Z scores were @ for weight-for-age ( @ % CI -@ to @ ) , @ in height-for-age ( -@ to @ ) , and @ in BMI-for-age ( -@ to @ ) .


We recorded no difference in blood pressure .


Adjusted differences were similar for all outcomes .


We recorded no differences in phenotype between children born to mothers who received antenatal multiple micronutrient or iron and folate supplements at age @ years .


Our findings did not extend to physiological differences or potential longer-term effects .


Nasal saline irrigation is a safe treatment for chronic rhinosinusitis ; however , its effect on olfaction is unclear .


Cyclic adenosine monophosphate ( cAMP ) is a key second messenger in the mechanism of olfaction and has been shown to be associated with smell function .


In animal studies , olfactory cilia may be harvested by simple saline preparations .


This study aimed to characterize the effect of nasal saline irrigation on smell function .


Volunteers with normal olfaction were randomized into a control or irrigation cohort .


In the initial appointment , subjects completed a University of Pennsylvania Smell Identification Test ( UPSIT ) and nasal samples were obtained by @ methods : the nasal curette and cytobrush .


The irrigation cohort performed daily nasal saline irrigations .


Both cohorts then returned in @ week .


The UPSIT and nasal cell collection were repeated , and each subject completed a subjective olfactory transition scale .


Nasal samples were processed for cAMP levels using a commercial assay .


Thirty-two subjects were enrolled and randomized into each cohort .


Control and postirrigation mean UPSIT scores were @ and @ ( p = @ ) .


No subjects reported a subjective smell loss .


Ten pairs of nasal samples were assayed .


Using the curette , control and postirrigation cAMP levels were @ and @ fmol / ( mg/mL ) , respectively ( p = @ ) .


Using the cytobrush , respective cAMP levels were @ and @ fmol / ( mg/mL ) , respectively ( p = @ ) .


Nasal saline irrigation has no subjective or objective effect on olfaction .


It also does not appear to affect cAMP levels , a potential marker of smell function .


To compare two electrosurgical techniques , straight-wire excision of transformation zone ( SWETZ ) with large loop excision of transformation zone , as a cone procedure ( LLETZ-cone ) , for the treatment of cervical intraepithelial neoplasia ( CIN ) , when disease is present at the cervical canal .


Randomised controlled trial .


Two public hospitals , one in Rio de Janeiro , Brazil and one in Dublin , Ireland .


One hundred and three women with indication to treat CIN located at cervical canal .


Women were randomised to receive LLETZ-cone or SWETZ .


Main outcome was the incidence of complete excision of disease at endocervical margin of the surgical specimen .


Secondary outcomes were complete excision at ectocervical and stromal margins , time to complete the procedure , specimen fragmentation , blood loss and death after @ year .


Fifty-two women were allocated to LLETZ-cone and @ to SWETZ .


Ten women were lost for main outcome because of damaged specimens .


Forty-two women in the LLETZ-cone group had free endocervical margin versus @ women in the SWETZ group ( relative risk @ , @ % confidence interval -LSB- @ % CI -RSB- @-@ @ ; P = @ ) .


For secondary outcomes related to margins , we observed a relative risk of @ ( @ % CI @-@ @ ; P = @ ) for ectocervical free margin .


For free stromal margin , the relative risk was @ ( @ % CI @-@ @ ; P = @ ) .


No death was observed .


This study was inconclusive ; SWETZ and LLETZ-cone were equally effective to treat endocervical disease , with no difference in protecting against margin involvement .


Higher , but not severe , blood loss and longer surgical time were observed in the SWETZ group .


Tissue hypoperfusion occurs frequently during surgery and may contribute to postoperative organ dysfunction .


There is a need for perioperative treatment protocols aiming at improving tissue oxygenation ( StO@ ) .


We hypothesised that intra-operative optimisation of StO@ improves tissue perfusion and thus reduces postoperative complications .


Furthermore , we evaluated the feasibility of the optimisation algorithm used .


We randomized @ high-risk patients , all > @ years with ASA physical status III , who underwent major abdominal surgery under standardized balanced general anesthesia combined with epidural analgesia .


Throughout surgery StO@ was monitored at the thenar eminence using near-infrared spectroscopy .


All patients were treated according to a standard care algorithm .


In addition , patients in the intervention group were treated with dobutamine if necessary to keep or raise StO@ % .


Data were recorded continuously and complications were recorded during hospital stay with a maximum of @ days .


The number of complications was not significantly different between groups ( @ vs @ ; p = @ ) .


Eleven patients in the intervention group had no complication , versus @ in the control group .


There was no significant difference between groups in length of stay in ICU or in hospital .


Only ten patients in the intervention group received dobutamine .


Administration of dobutamine resulted in a moderate @ -LSB- -@ to @ -RSB- % increase of StO@ .


The overall protocol adherence was @ % .


No statistically significant difference in outcome was realized through intraoperative optimization of StO@ values in this pilot study .


The protocol used may be considered feasible for clinical practice .


Further research is obligatory to define both the optimal StO@ threshold and intervention to treat tissue hypoperfusion .


To compare the pharmacodynamic effects of the highest approved doses of the sodium glucose co-transporter @ ( SGLT@ ) inhibitors canagliflozin and dapagliflozin on urinary glucose excretion ( UGE ) , renal threshold for glucose excretion ( RTG ) and postprandial plasma glucose ( PPG ) excursion in healthy participants in a randomized , double-blind , two-period crossover study .


In each treatment period , participants ( n = @ ) received canagliflozin @mg or dapagliflozin @mg for @days ( @min before breakfast ) .


A mixed-meal tolerance test ( @kcal ; @g glucose ) was performed at baseline and on day @ of each treatment period to assess changes in incremental PPG ( PPGAUC@-@ h ) .


We measured @-h UGE and plasma glucose on day @ to determine @-h mean RTG .


Canagliflozin @mg and dapagliflozin @mg had similar effects on UGE and RTG for @h after dosing , but canagliflozin was associated with higher UGE and greater RTG reductions for the remainder of the day .


Mean @-h UGE was @ % higher with canagliflozin than with dapagliflozin ( @ vs. @ g ) , and @-h mean RTG was @ mmol/l ( @ mg/dl ) lower with canagliflozin than with dapagliflozin ( @ vs. @ mmol/l ; p < @ ) .


Dapagliflozin had no effect on PPG excursion ; canagliflozin delayed and reduced PPG excursion ( between-treatment difference in PPGAUC@-@ h from baseline expressed as a percentage of baseline mean , -@ % ; p = @ ) .


Canagliflozin and dapagliflozin were generally well tolerated .


In healthy participants , canagliflozin @mg provided greater @-h UGE , a lower RTG and smaller PPG excursions than dapagliflozin @mg .


In postmenopausal osteoporotic women , denosumab fully inhibits teriparatide-induced bone resorption at approved doses .


This property of denosumab is distinct from that of alendronate and likely contributes to the efficacy of combination denosumab and teriparatide therapy .


Whether denosumab fully inhibits bone resorption when challenged by a higher dose of teriparatide is unknown .


We aimed to define the comparative ability of denosumab and alendronate to block the acute proresorptive effects of high-dose teriparatide .


In this randomized controlled trial , bone resorption ( serum C-telopeptide -LSB- CTX -RSB- ) was measured in @ postmenopausal women prior to and @ hours after a single @-g sc teriparatide injection .


Subjects then received either a single injection of denosumab @ mg or oral alendronate @ mg weekly for @ weeks .


After @ weeks , serum CTX was again measured before and @ hours after a teriparatide a @-g injection .


The primary outcome was the between-group difference in the teriparatide-induced change in CTX from baseline to week @ .


At baseline , @ g of teriparatide induced similar @-hour increases in mean CTX in both groups ( alendronate @ % @ % , denosumab @ % @ % ) .


After @ weeks , teriparatide was still able to stimulate bone resorption in women treated with alendronate ( mean CTX increase of @ % @ % ) but not in women treated with denosumab ( -@ % @ % ; P < @ for between group comparison ) .


Denosumab , but not alendronate , fully inhibits the ability of high-dose teriparatide to increase bone resorption acutely .


These results suggest that combining denosumab with a more potent anabolic stimulus may result in greater separation between bone resorption and formation and hence greater increases in bone mass .


This paper reports a cluster analysis of a sample recruited from a randomized controlled trial that explored the effect of using a life story work approach to improve the psychological outcomes of older people in the community .


@ subjects from community centers were included in this analysis .


After statistical testing , @ seniors were assigned to the active ageing ( AG ) cluster and @ to the inactive ageing ( IG ) cluster .


Those in the AG were younger and healthier , with fewer chronic diseases and fewer depressive symptoms than those in the IG .


They were more satisfied with their lives , and had higher self-esteem .


They met with their family members more frequently , they engaged in more leisure activities and were more likely to have the ability to move freely .


In summary , active ageing was observed in people with better health and functional performance .


Our results echoed the limited findings reported in the literature .


Rehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty ( TKA ) .


As demands for rehabilitation at home are growing and becoming more difficult to meet , in-home telerehabilitation has been proposed as an alternate service delivery method .


However , there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation .


The objective of this study was to document , analyze , and compare real costs of two service delivery methods : in-home telerehabilitation and conventional home visits .


The economic analysis was conducted as part of a multicenter randomized controlled trial ( RCT ) on telerehabilitation for TKA , and involved data from @ patients , post-TKA .


Twice a week for @ weeks , participants received supervised physiotherapy via two delivery methods , depending on their study group allocation : in-home telerehabilitation ( TELE ) and home-visit rehabilitation ( VISIT ) .


Patients were recruited from eight hospitals in the province of Quebec , Canada .


The TELE group intervention was delivered by videoconferencing over high-speed Internet .


The VISIT group received the same intervention at home .


Costs related to the delivery of the two services ( TELE and VISIT ) were calculated .


Student 's t tests were used to compare costs per treatment between the two groups .


To take distance into account , the two treatment groups were compared within distance strata using two-way analyses of variance ( ANOVAs ) .


The mean cost of a single session was Can $ @ for the VISIT group ( SD $ @ ) and $ @ for the TELE group ( SD $ @ ) .


When comparing both groups , real total cost analysis showed a cost differential in favor of the TELE group ( TELE minus VISIT : - $ @ , @ % CI - $ @ to - $ @ ) .


However , when the patient 's home was located less than @ km round-trip from the health care center , the difference in costs between TELE and VISIT treatments was not significant ( P = @ , @ , and @ for the < @ , @-@ , and @-@ km strata , respectively ) .


The cost of TELE treatments was lower than VISIT treatments when the distance was @ km or more ( @-@ km : $ @ < $ @ , P = @ ; @ km : $ @ < $ @ , P < @ ) .


To our knowledge , this is the first study of the actual costs of in-home telerehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient 's home .


The cost for a single session of in-home telerehabilitation compared to conventional home-visit rehabilitation was lower or about the same , depending on the distance between the patient 's home and health care center .


Under the controlled conditions of an RCT , a favorable cost differential was observed when the patient was more than @ km from the provider .


Stakeholders and program planners can use these data to guide decisions regarding introducing telerehabilitation as a new service in their clinic .


This study aimed to determine the probability and risk factors for developing a corneal inflammatory event ( CIE ) during daily wear of lotrafilcon A silicone hydrogel contact lenses .


Eligible participants ( n = @ ) were fit with lotrafilcon A lenses for daily wear and followed up for @ months .


Participants were randomized to either a polyhexamethylene biguanide-preserved multipurpose solution or a one-step peroxide disinfection system .


The main exposures of interest were bacterial contamination of lenses , cases , lid margins , and ocular surface .


Kaplan-Meier ( KM ) plots were used to estimate the cumulative unadjusted probability of remaining free from a CIE , and multivariate Cox proportional hazards regression was used to model the hazard of experiencing a CIE.


The KM unadjusted cumulative probability of remaining free from a CIE for both lens care groups combined was @ % ( @ % confidence interval -LSB- CI -RSB- , @ to @ % ) .


There was one participant with microbial keratitis , five participants with asymptomatic infiltrates , and seven participants with contact lens peripheral ulcers , providing KM survival estimates of @ % ( @ % CI , @ to @ % ) and @ % ( @ % CI , @ to @ % ) for remaining free from noninfectious and symptomatic CIEs , respectively .


The presence of substantial ( > @ colony-forming units ) coagulase-negative staphylococci bioburden on lid margins was associated with about a five-fold increased risk for the development of a CIE ( p = @ ) .


The probability of experiencing a CIE during daily wear of lotrafilcon A contact lenses is low , and symptomatic CIEs are rare .


Patient factors , such as high levels of bacterial bioburden on lid margins , contribute to the development of noninfectious CIEs during daily wear of silicone hydrogel lenses .


Home-based exercise has been shown to provide benefits in terms of physical capacity in the general population , but has been scarcely investigated in patients with chronic kidney disease ( CKD ) .


To evaluate the impact of a home-based aerobic training on the cardiopulmonary and functional capacities of overweight non-dialysis-dependent patients with CKD ( NDD-CKD ) .


Twenty-nine sedentary patients ( @ @ years , BMI = @ @ kg/m ( @ ) , eGFR = @ @ mL/min/@ @ m ( @ ) ) were randomly assigned to a home-based exercise group ( n = @ ) or to a control group ( n = @ ) that remained without performing exercise .


Aerobic training was performed three times per week for @ weeks .


A cardiopulmonary exercise test , functional capacity and clinical parameters were evaluated .


A significant increase , ranging from @ to @ % , was observed in the cardiopulmonary capacity parameters , such as maximal ventilation ( p = @ ) , VO@peak ( p = @ ) , ventilatory threshold ( p = @ ) and respiratory compensation point ( p < @ ) , of the exercise group .


A simultaneous improvement in the functional capacity tests -LSB- @-min walk test ( p < @ ) , time up and go test ( p < @ ) , arm curl test ( p < @ ) , sit and stand test ( p < @ ) , @-min step test ( p < @ ) and back scratch test ( p = @ ) -RSB- was also found in patients who were submitted to the exercise .


Exercised patients experienced a decrease in systolic and diastolic blood pressure , average @ % ( p < @ ) and @ % ( p = @ ) , respectively , and a trend toward improved renal function ( p = @ ) .


No change in any parameter was found in the control group during the follow-up .


The home-based aerobic exercise program was feasible , safe and effective for the improvement in the cardiopulmonary and functional capacities of overweight NDD-CKD patients .


To assess the effectiveness of the Healthy School and Drugs ( HSD ) program for secondary schools on the development of substance use among Dutch early adolescents and to explore whether boys , adolescents of lower educational backgrounds , or adolescents high on personality risk traits , would benefit more from the HSD program than others .


Randomized clustered trial with two intervention conditions ( i.e. , lessons and integral ) among a general population of adolescents in the Netherlands .


A total of @ students of @ Dutch secondary schools .


Structured digital questionnaires were administered pre-intervention and at @ , @ , and @months follow-ups .


The outcome measure was the rate of change in substance use across follow-ups .


Differential effectiveness of the HSD program was examined for sex , educational level , and personality traits .


Our results show no HSD intervention effects on the development of substance use .


Sex , education level , and personality characteristics of the participants did not moderate the intervention effects .


The absence of effects of the Healthy School and Drugs program on the development of substance use indicates that the program should be renewed and redeveloped .


Cross-sectional diagnostic accuracy study .


To investigate the relationship between history and physical examination findings and the outcome of electrodiagnostic testing in patients with sciatica referred to physical therapy .


Electrodiagnostic testing is routinely used to evaluate patients with sciatica .


Recent evidence suggests that the presence of radiculopathy identified with electrodiagnostic testing may predict better functional outcomes in these patients .


While some patient history and physical examination findings have been shown to predict the presence of disc herniation or neurological insult , little is known about their relationship to the results of electrodiagnostic testing .


Electrodiagnostic testing was performed on @ patients with sciatica who participated in a randomized trial that compared different physical therapy interventions .


The diagnostic gold standard was the presence or absence of radiculopathy , based on the results of the needle electromyographic examination .


Diagnostic sensitivity and specificity values were calculated , along with corresponding likelihood ratios , for select patient history and physical examination variables .


No significant relationship was found between select patient history and physical examination findings , analyzed individually or in combination , and the outcome of electrodiagnostic testing .


Diagnostic sensitivity values ranged from @ ( @ % confidence interval -LSB- CI -RSB- : @ , @ ) to a high of @ ( @ % CI : @ , @ ) , and specificity values ranged from @ ( @ % CI : @ , @ ) to a high of @ ( @ % CI : @ , @ ) .


Positive likelihood ratios ranged from @ ( @ % CI : @ , @ ) to a high of @ ( @ % CI : @ , @ ) , and negative likelihood ratios ranged from @ ( @ % CI : @ , @ ) to a low of @ ( @ % CI : @ , @ ) .


In this investigation , the relationship between patient history and physical examination findings and the outcome of electrodiagnostic testing among patients with sciatica was not found to be statistically significant or clinically meaningful .


However , given the small sample size and corresponding large CIs , these results should be considered with caution , recognizing that some of the history and physical examination variables may prove useful in future research .


These findings suggest that electrodiagnostic testing is essential to identify the subgroup of patients with sciatica who have measurable nerve injury consistent with radiculopathy , which may be an important prognostic factor for recovery .


Level of Evidence Diagnosis , level @b - .


J Orthop Sports Phys Ther @ ; @ ( @ ) :@ -@ .


Epub @ May @ .


doi :@ / jospt @ .


This analysis is based on a survey questionnaire designed to describe medical educators ' views of psychiatry and psychiatrists .


Our goals in this paper were to assess the psychometric properties of the survey questions by ( a ) using exploratory factor analysis to identify the basic factor structure underlying @ survey items ; ( b ) testing the resulting factor structure using confirmatory factor analysis ; and ( c ) assessing the internal reliability of each identified factor .


To our knowledge , this is the first attempt to use these techniques to psychometrically assess a scale measuring the strength of stigma that medical educators attached to psychiatry .


Survey data were collected from a random sample of @,@ teaching faculty in @ academic teaching sites in @ countries .


We conducted exploratory and confirmatory factor analysis to identify the scale structure and Cronbach 's alpha to assess internal consistency of the resulting scales .


Results showed that a two-factor solution was the best fit for the data .


Following exploratory factor analysis , we conducted confirmatory factor analysis on a split half of the sample .


Results highlighted several items with low loadings .


Excluding factors with low correlations and allowing for several correlated variances resulted in a good fitting model explaining @ % of the variance in the data .


We identified two unidimensional scales .


The Images Scale contained @ items measuring stereotypic content concerning psychiatry and psychiatrists .


The Efficacy of Psychiatry Scale contained @ items addressing perceptions of the challenges and effectiveness of psychiatry as a discipline .


To evaluate the efficacy of Ginkgo biloba as a complementary therapy for attention-deficit/hyperactivity disorder ( ADHD ) .


Children and adolescents with ADHD received methylphenidate ( @-@ mg/day ) plus either G. biloba ( @-@ mg/day ) or placebo for @ weeks .


Parent and teacher forms of the ADHD Rating Scale-IV ( ADHD-RS-IV ) were completed at baseline , week @ , and week @ .


Treatment response was defined as @ % improvement from baseline in the ADHD-RS-IV .


Compared with placebo , more reduction was observed with G. biloba regarding ADHD-RS-IV parent rating inattention score ( -@ @ vs. -@ @ , P < @ ) and total score ( -@ @ vs. -@ @ , P = @ ) as well as teacher rating inattention score ( -@ @ vs. -@ @ , P = @ ) .


Response rate was higher with G. biloba compared with placebo based on parent rating ( @ % vs. @ % , P = @ ) .


The G. biloba is an effective complementary treatment for ADHD .


Further studies with longer treatment duration are warranted in this regard .


IRCT@N@ .


To evaluate the long-term efficacy of pain reduction by two dose fractionation schedules used for low-dose radiotherapy of painful elbow syndrome .


Between February @ and February @ , @evaluable patients were recruited for this prospective trial .


All patients received low-dose orthovoltage radiotherapy .


One course consisted of @fractions in @weeks .


In the case of insufficient pain remission after @weeks , a second course was administered .


Patients were randomly assigned to one of two groups to receive single doses of either @ or @ Gy .


Endpoint was pain reduction .


Pain was measured before radiotherapy , as well as immediately after ( early response ) , @weeks after ( delayed response ) and approximately @years after ( long-term response ) completion of radiotherapy using a questionnaire-based visual analogue scale ( VAS ) and a comprehensive pain score ( CPS ) .


Median follow-up was @months ( range @-@months ) .


The overall early , delayed and long-term response rates for all patients were @ , @and @ % , respectively .


The mean VAS scores before treatment and those for early , delayed and long-term response in the @ - and @-Gy groups were @ and @ ( p = @ ) ; @ and @ ( p = @ ) ; @ and @ ( p = @ ) and @ and @ ( p = @ ) , respectively .


The mean CPS values before treatment and those for early , delayed and long-term response were @ and @ ( p = @ ) ; @ and @ ( p = @ ) ; @ and @ ( p = @ ) and @ and @ ( p = @ ) , respectively .


No significant differences in the quality of the long-term response were found between the @ - and @-Gy arms ( p = @ ) .


Low-dose radiotherapy is an effective treatment for the management of benign painful elbow syndrome .


For radiation protection reasons , the dose for a radiotherapy series should not exceed @ Gy .


A recent clinical trial could not find differences between anti-inflammatory drugs , antibiotics and placebo in shortening the duration of symptoms in acute bronchitis .


To investigate if C-reactive protein ( CRP ) concentrations at presentation are predictive of symptom resolution in these patients .


We performed a secondary analysis of the data from a placebo-controlled , randomized clinical trial carried out in primary care .


Patients from @ to @ years of age presenting a respiratory tract infection of < @ week of evolution , with cough as the predominant symptom and the presence of discoloured expectoration , were enrolled in the study .


On the baseline visit , CRP was determined in capillary blood and a five-item symptom diary was given .


Patients were followed up to @ days .


The main outcome measure was the number of days with persistent cough .


A total of @ subjects fulfilled all the criteria for the efficacy analysis and had undergone the CRP test ; of these , @ % presented a CRP value < @ mg/l and @ % presented < @ mg/l .


There were no significant differences in the median duration of cough : @ days among patients with CRP concentrations < @ mg/l -LSB- @ % confidence interval ( CI ) : @-@ days -RSB- , @ days among those with concentrations ranging from @ to @ mg/l ( @ % CI : @-@ ) and @ days in those with CRP > @ mg/l ( @ % CI : @-@ ) ( P = @ ) .


Among patients with uncomplicated acute bronchitis and discoloured sputum , the CRP concentrations at presentation are not helpful for predicting symptom resolution .


Proxy measures are an alternative source of data for care home residents who are unable to complete the health utility measure , but the agreement levels between residents and care home staff for the EQ-@D have not been investigated previously .


The objective of the present study was to examine the inter-rater agreement levels for the reporting of EQ-@D by care home residents and staff , adjusting for the impact of clustering .


The data consist of EQ-@D scores for @ pairs of care home residents and proxies and quality-adjusted life-years ( QALYs ) for @ pairs .


Cluster-adjusted agreement was compared for the domains , index scores , and QALYs from the EQ-@D .


Factors influencing index score agreement are also described .


The results show poor to fair agreement at the domain level ( cluster-adjusted Kappa -@ to @ ) and moderate agreement at the score level ( cluster-adjusted intra-class correlation coefficient -LSB- ICC -RSB- @-@ @ ) and for QALYs ( cluster-adjusted ICC @ ) .


A higher likelihood of depression and lower cognitive impairment were both associated with smaller discrepancy between proxy and self-completed scores .


Proxies appear to be an acceptable source of data for index scores and QALYs but may be less reliable if individual domains are considered .


Knee osteoarthritis ( OA ) causes pain and long-term disability with annual healthcare costs exceeding $ @ billion in the United States .


Few medical remedies effectively influence the course of the disease .


Finding effective treatments to maintain function and quality of life in patients with knee OA is one of the national priorities identified by the Institute of Medicine .


We are currently conducting the first comparative effectiveness and cost-effectiveness randomized trial of Tai Chi versus a physical-therapy regimen in a sample of patients with symptomatic and radiographically confirmed knee OA .


This article describes the design and conduct of this trial .


A single-center , @-week , comparative effectiveness randomized controlled trial of Tai Chi versus a standardized physical-therapy regimen is being conducted at an urban tertiary medical center in Boston , Massachusetts .


The study population consists of adults@ years of age with symptomatic and radiographic knee OA ( American College of Rheumatology criteria ) .


Participants are randomly allocated to either @ weeks of Tai Chi ( @x/week ) or Physical Therapy ( @x/week for @ weeks , followed by @ weeks of rigorously monitored home exercise ) .


The primary outcome measure is pain ( Western Ontario and McMaster Universities WOMAC ) subscale at @ weeks .


Secondary outcomes include WOMAC stkiffness and function domain scores , lower extremity strength and power , functional balance , physical performance tests , psychological and psychosocial functioning , durability effects , health related quality of life , and healthcare utilization at @ , @ and @ weeks .


This study will be the first randomized comparative-effectiveness and cost-effectiveness trial of Tai Chi versus Physical Therapy in a large symptomatic knee OA population with long-term follow up .


We present here a robust and well-designed randomized comparative-effectiveness trial that also explores multiple outcomes to elucidate the potential mechanisms of mind-body effect for a major disabling disease with substantial health burdens and economic costs .


Results of this study are expected to have important public health implications for the large and growing population with knee OA .


General anesthesia ( GA ) is considered the gold standard for external dacryocystorhinostomy ( DCR ) surgery .


There are few reports about laryngeal mask airway ( LMA ) use in DCR surgery .


The aim of this study was to compare the use of endotracheal intubation ( ETT ) vs LMA for airway management during DCR surgery .


Ninety patients were randomized to two groups .


In the group C , ETT and in the group L , classic LMA was used to maintain and protect the airway during the procedure .


Hemodynamic data before , after intubation or LMA insertion and after skin incisions were recorded .


Coughing and straining at the end of anesthesia and postoperative nausea and vomiting ( PONV ) were recorded .


In the group L , the mean arterial pressure and the heart rate after LMA insertion and after the skin incisions were significantly lower than the group C ( p < @ ) .


Furthermore , incidence of coughing , straining at the end of anesthesia and PONV was lower in the group L than the group C ( p < @ ) .


LMA can be used in external DCR , to decrease the hemodynamic changes , to decrease coughing , straining at the end of anesthesia and the incidence of PONV .


Optimization of glycemic control is critical to reduce the number of diabetes mellitus-related complications , but long-term success is challenging .


Although vision loss is among the greatest fears of individuals with diabetes , comprehensive personalized diabetes education and risk assessments are not consistently used in ophthalmologic settings .


To determine whether the point-of-care measurement of hemoglobin A ( @c ) ( HbA ( @c ) ) and personalized diabetes risk assessments performed during retinal ophthalmologic visits improve glycemic control as assessed by HbA ( @c ) level .


Ophthalmologist office-based randomized , multicenter clinical trial in which investigators from @ sites were randomly assigned to provide either a study-prescribed augmented diabetes assessment and education or the usual care .


Adults with type @ or @ diabetes enrolled into @ cohorts : those with a more-frequent-than-annual follow-up ( @ control participants and @ intervention participants ) and those with an annual follow-up ( @ control participants and @ intervention participants ) .


Enrollment was from April @ through January @ .


Point-of-care measurements of HbA@c , blood pressure , and retinopathy severity ; an individualized estimate of the risk of retinopathy progression derived from the findings from ophthalmologic visits ; structured comparison and review of past and current clinical findings ; and structured education with immediate assessment and feedback regarding participant 's understanding .


These interventions were performed at enrollment and at routine ophthalmic follow-up visits scheduled at least @ weeks apart .


Mean change in HbA ( @c ) level from baseline to @-year follow-up .


Secondary outcomes included body mass index , blood pressure , and responses to diabetes self-management practices and attitudes surveys .


In the cohort with more-frequent-than-annual follow-ups , the mean ( SD ) change in HbA ( @c ) level at @ year was -@ % ( @ % ) in the control group and -@ % ( @ % ) in the intervention group ( adjusted mean difference , -@ % -LSB- @ % CI , -@ % to @ % -RSB- ; P = @ ) .


In the cohort with annual follow-ups , the mean ( SD ) change in HbA ( @c ) level was @ % ( @ % ) in the control group and -@ % ( @ % ) in the intervention group ( mean difference , -@ % -LSB- @ % CI , -@ % to @ % -RSB- ; P = @ ) .


Results were similar for all secondary outcomes .


Long-term optimization of glycemic control is not achieved by a majority of individuals with diabetes .


The addition of personalized education and risk assessment during retinal ophthalmologic visits did not result in a reduction in HbA ( @c ) level compared with usual care over @ year .


These data suggest that optimizing glycemic control remains a substantive challenge requiring interventional paradigms other than those examined in our study .


To determine whether manual wheelchair configuration impacts how well a person who has acquired brain injury ( ABI ) related hemiparesis performs functional tasks from his or her wheelchair .


Multi-treatment cross-over design .


Inpatient rehabilitation hospital .


Nineteen patients with ABI resulting in hemiparesis undergoing inpatient rehabilitation ( average of @ days post-injury ( @ days ) ; age range , @-@ ; @ with mechanical brain injury , @ with cerebral vascular accident ) .


Participants in the study were placed in two different wheelchair configurations ( position one and position two ) and were randomized as to which position they were placed in first .


All outcome measures were taken twice on each individual within each wheelchair configuration during two consecutive days .


Timed Forward Wheeling ( TFW ) , Modified Functional Reach test ( MFR ) , Visual Analogue Scale for Comfort ( VAS ) , transfer score from the Functional Independence Measure ( FIM ) , measurement of popliteal fossa to front of cushion .


The position two seating group 's TFW was significantly faster than the position one seating group at both time points .


There were no significant differences in the MFR scores , VAS comfort scale scores , and FIM transfer score between the two groups .


A wheelchair configuration with no seat slope , solid backrest mounted at @ degree ( @ degrees ) seat to back angle , and use of a solid seat insert with a flat foam cushion ( position two ) results in greater efficiency in foot propulsion for individuals with ABI than a wheelchair configuration with one inch of seat slope , solid backrest mounted at @ degree ( @ degrees ) seat to back angle , and no solid seat insert with a gel/foam contoured cushion ( position @ ) .


In primary care the diagnosis of CHF and ECF accumulation is no triviality .


We aimed to predict plasma BNP , CHF and ECF accumulation with segmental impedance spectroscopy while using and extending the electrodes of the conventional electrocardiography .


Three combined multiple electrodes were added to the @ lead ECG for segmental impedance spectroscopy and for measuring the maximal rate of segmental fluid volume change with heart action at the thorax and the legs .


The obtained signals were analyzed by partial correlation analyses in comparison with plasma BNP , CHF classes , ejection fraction by echocardiography and cardiac index by double gas re-breathing .


@ subjects ( @ healthy volunteers , @ patients with CHF , NYHA classes II to IV and @ patients without CHF ) were investigated .


The maximal rate of volume change with heart action at the thorax and at the legs , as well as the ECF/ICF ratio at the legs contribute equally and independently to the prediction of BNP and heart failure in an unknown test sample of @ patients ( multiple r = @ , p < @ ) .


The ROC-curve for the predicted plasma BNP > @ pg/ml gave an AUC = @ .


The absence or the presence of heart failure could be predicted correctly by a binomial logistic regression in @ and @ % of cases , respectively .


The methodology , which is based on inverse coupling of BNP release and of maximal blood acceleration and on sensitive detection of ECF overload , could enable the diagnosis of CHF with useful sensitivity and specificity while writing a routine-ECG .


Although continuing education is necessary for practicing nurses , it is very difficult to organize traditional classes because of large numbers of nurses and working shifts .


Considering the increasing development of mobile electronic learning , we carried out a study to compare effects of the traditional face to face method with mobile learning delivered as text messages by cell phone .


Sixty female nurses working in our hospital were randomly divided into class and short message service ( SMS ) groups .


Lessons concerning breast cancer screening were prepared as @ messages and sent in @ days for the SMS group , while the class group participated in a class held by a university lecturer of breast and cancer surgery .


Pre - and post-tests were undertaken for both groups at the same time ; a retention test also was performed one month later .


For statistical analysis , the paired T test and the independent sample T test were used with SPSS software version @ ; p < @ was considered significant .


Mean age and mean work experience of participants in class and SMS groups was @ , @ , @ , and @ , respectively .


There was a significant increase in mean score post-tests ( compared with pre-tests ) in both groups ( p < @ ) .