The main triggering factor , as well as the worsening of pain , was the patient manipulation , both with a prevalence of @ % .


The main treatment for low back pain before this research was the use of medication , with a prevalence of @ % .


In accordance with a variance analysis , only G@ presented a significant statistical difference , with a better result after @ sessions .


Massage presented an enormous effect ( d = @ ) , corresponding to @ % of reduction in the pain level .


Massage was effective to decrease occupational low back pain of those Nursing workers .


Olive oil protects against cardiovascular disease but the underlying mechanism is still unclear .


We speculated that olive oil could inhibitoxidative stress , which is believed to be implicated in the atherosclerotic process .


Post-prandial oxidative stress and endothelial dysfunction were investigated in twenty-five healthy subjects who were randomly allocated in a cross-over design to a Mediterranean diet added with or without extra virgin olive oil ( EVOO , @g ) ( first study , n = @ ) or Mediterranean diet with EVOO ( @g ) or corn oil ( @g ) ( second study , n = @ ) .


Oxidative stress biomarkers including platelet reactive oxidant species ( ROS ) and @-iso-PGF@-III , activity of NOX@ , the catalytic sub-unit of NADPH oxidase , as assessed in platelets and serum , serum vitamin E and endothelial dysfunction , were measured before and @h after lunch .


In the first study a significant increase of platelet ROS , @-iso-PGF@-III , NOX@ activity , sE-selectin , sVCAM@ and a decrease of serum vitamin E were detected in controls but not when EVOO was included in the Mediterranean diet ; oxidative stress and endothelial dysfunction increase were also observed in the second study in subjects given corn oil .


A significant correlation was found between NOX@ activity and platelet oxidative stress .


Invitro study demonstrated that EVOO but not corn oil significantly decreased platelet and PMNs oxidative stress and NOX@ activity .


The study provides the first evidence that post-prandial oxidative stress may be triggered by NOX@ up-regulation .


EVOO but not corn oil , is able to counteract such phenomenon suggesting that addition of EVOO to a Mediterranean diet protects against post-prandial oxidative stress .


Persistently poor glycemic control in adult type @ diabetes patients is a common , complex , and serious problem initiating significant damage to the cardiovascular , renal , neural , and visual systems .


Currently , there is a plethora of low-cost and free diabetes self-management smartphone applications available in online stores .


The aim of this study was to examine the effectiveness of a freely available smartphone application combined with text-message feedback from a certified diabetes educator to improve glycemic control and other diabetes-related outcomes in adult patients with type @ diabetes in a two-group randomized controlled trial .


Patients were recruited through an online type @ diabetes support group and letters mailed to adults with type @ diabetes throughout Australia .


In a @-month intervention , followed by a three-month follow-up , patients ( n = @ ) were randomized to usual care ( control group ) or usual care and the use of a smartphone application ( Glucose Buddy ) with weekly text-message feedback from a Certified Diabetes Educator ( intervention group ) .


All outcome measures were collected at baseline and every three months over the study period .


Patients ' glycosylated hemoglobin levels ( HbA@c ) were measured with a blood test and diabetes-related self-efficacy , self-care activities , and quality of life were measured with online questionnaires .


The mean age of patients was @ years ( SD @ ) ( @ male , @ female ) , @ % ( @/@ ) were male , and patients had been diagnosed with type @ diabetes for a mean of @ years ( SD @ ) .


Of the initial @ patients , @ completed the study ( @ intervention , @ control group ) .


The intervention group significantly improved glycemic control ( HbA@c ) from baseline ( mean @ % , SD @ ) to @-month follow-up ( mean @ % , SD @ ) , compared to the control group ( baseline : mean @ % , SD @ , follow-up : mean @ % , SD @ ) .


No significant change over time was found in either group in relation to self-efficacy , self-care activities , and quality of life .


In adjunct to usual care , the use of a diabetes-related smartphone application combined with weekly text-message support from a health care professional can significantly improve glycemic control in adults with type @ diabetes .


Failed intubation may result in both increased morbidity and mortality .


The combination of a video laryngoscope and a flexible tracheoscope used as a flexible video stylet may improve the success rate of securing a difficult airway .


We tested the hypothesis that this combination is a feasible way to facilitate intubation in patients with a predicted difficult airway in that it will shorten intubation times and reduce the number of intubation attempts .


We conducted a randomized , prospective trial in @ patients with anticipated difficult airways undergoing elective or urgent surgery .


After insertion of video laryngoscope , patients were randomly assigned to either having their tube placed with the use of a preformed stylet ( control group ) or with a flexible tracheoscope ( intervention group ) .


The primary outcome measures were time to successful intubation and number of intubation attempts .


The number of intubations requiring @ or more intubation attempts was similar in the @ groups ( @ % control vs @ % intervention , P = @ ) ; the number of patients requiring @ or more intubation attempts was not significantly different ( @ % control vs @ % intervention , P = @ ) .


Distribution for time to intubation also did not differ between the control ( median of @ seconds , interquartile range @-@ ) and the intervention group ( median of @ seconds , interquartile range @-@ ; P = @ ) .


In the control group , @ patients , all with cervical spine pathology , had the trachea intubated successfully with the video laryngoscope plus flexible tracheoscope after @ failed attempts with video laryngoscope and rigid stylet .


For these @ patients , time from the decision to change the intubation method to successful intubation with a flexible tracheoscope was @ @ seconds .


Overall success probability for cervical spine patients was @ % ( @/@ ) in the intervention group and @ % ( @/@ ) in the control group , with an exact @ % confidence interval for the difference of @ % to @ % , P = @ .


Flexible tracheoscope-assisted video laryngoscopic intubation is a feasible alternative to video laryngoscope only intubation in patients with predicted difficult airways .


A flexible tracheoscope used in combination with video laryngoscope may also further increase the success rate of intubation in select patients with a proven difficult airway , particularly when in-line stabilization is required .


Hypomethylating agents have demonstrated activity in patients with myelodysplastic syndrome ( MDS ) and acute myeloid leukemia ( AML ) .


Preclinical and single-arm trials have suggested that adding histone deacetylase ( HDAC ) inhibitors may synergize the epigenetic modulation of hypomethylating agents and improve treatment results .


The objective of this study was to evaluate the possible benefit of adding valproic acid , an HDAC inhibitor , to decitabine in the treatment of MDS and AML .


Patients with higher risk MDS or with AML aged @ years were eligible .


Patients were randomized in a Bayesian response-adaptive design to receive intravenous decitabine @ mg/m ( @ ) daily for @ days or decitabine plus oral valproic acid @ mg/kg daily for @ days .


Courses were repeated every @ to @ weeks .


A maximum of @ patients were to be treated .


In total , @ patients were treated on study , including @ patients with MDS and @ patients with AML .


The median patient age was @ years ( range , @-@ years ; @ % of patients were aged @ years ) .


Overall , @ % of patients achieved complete remission , and @ % had an objective response .


The median survival was @ months , and the estimated @-year survival rate was @ % .


Outcome was not different with the addition of valproic acid to decitabine versus decitabine alone in relation to the rates of complete remission , overall response , or survival .


Subset analyses did not demonstrate a benefit within the MDS or AML categories .


Toxicities-particularly neurotoxicities-were higher with the combination arm .


Adding valproic acid to decitabine was not associated with improved outcome in the treatment of patients with MDS or elderly patients with AML .


Future therapies may consider combining hypomethylating agents with better HDAC inhibitors and using different schedules .


To compare the effects and short-term outcomes of pressure support ventilation with volume guarantee versus synchronized intermittent mandatory ventilation in the weaning phase of very low-birth weight infants with respiratory distress syndrome .


Randomized controlled prospective study .


Tertiary care neonatal unit .


A total of @ premature infants who were less than @ weeks ' gestation and/or less than @,@ g birth weight and received mechanical ventilation because of respiratory distress syndrome were studied .


All infants were ventilated from the time of admission with synchronized intermittent positive pressure ventilation mode after surfactant treatment for respiratory distress syndrome and then switched to pressure support ventilation with volume guarantee or synchronized intermittent mandatory ventilation mode in the weaning phase .


The ventilatory variables and neonatal outcomes were recorded in each group .


The mean peak inflation pressure was higher in synchronized intermittent mandatory ventilation group ( p < @ ) and the mean airway pressure was higher in pressure support ventilation with volume guarantee group ( p = @ ) , whereas mean tidal volume and respiratory rates were similar in both groups .


The prevalence of postextubation atelectasis was higher in synchronized intermittent mandatory ventilation group , but the difference was not statistically significant ( p = @ ) .


No differences were found in the prevalence of reintubation , patent ductus arteriosus , intraventricular hemorrhage , retinopathy of prematurity , bronchopulmonary dysplasia , and pneumothorax between the groups .


Pressure support ventilation with volume guarantee mode may be a safe and feasible mode during the weaning phase of very low-birth weight infants on mechanical ventilation support for respiratory distress syndrome with respect to reducing the frequency of postextubation atelectasis and using less peak inflation pressure .


To describe the study design and methodology for the p-EVES study , a trial designed to determine the effectiveness , cost-effectiveness and acceptability of portable Electronic Vision Enhancement System ( p-EVES ) devices and conventional optical low vision aids ( LVAs ) for near tasks in people with low vision .


The p-EVES study is a prospective two-arm randomised cross-over trial to test the hypothesis that , in comparison to optical LVAs , p-EVES can be : used for longer duration ; used for a wider range of tasks than a single optical LVA and/or enable users to do tasks that they were not able to do with optical LVAs ; allow faster performance of instrumental activities of daily living ; and allow faster reading .


A total of @ adult participants with visual impairment are currently being recruited from Manchester Royal Eye Hospital and randomised into either Group @ ( receiving the two interventions A and B in the order AB ) , or Group @ ( receiving the two interventions in the order BA ) .


Intervention A is a @-month period with conventional optical LVAs and a p-EVES device , and intervention B is a @-month period with conventional optical LVAs only .


The study adopts a mixed methods approach encompassing a broad range of outcome measures .


The results will be obtained from the following primary outcome measures : Manchester Low Vision Questionnaire , capturing device ` usage ' data ( which devices are used , number of times , for what purposes , and for how long ) and the MNRead test , measuring threshold print size , critical print size , and acuity reserve in addition to reading speed at high ( @ % ) contrast .


Results will also be obtained from a series of secondary outcome measures which include : assessment of timed instrumental activities of daily living and a ` near vision ' visual functioning questionnaire .


A companion qualitative study will permit comparison of results on how , where , and under what circumstances , p-EVES devices and LVAs are used in daily life .


A health economic evaluation will provide results on : the incremental cost-effectiveness of p-EVES compared to optical magnifiers ; cost-effectiveness ; and cost-utility .


The evidence base in low vision rehabilitation is modest and further high quality clinical trials are required to inform decisions on healthcare provision .


The p-EVES study findings are anticipated to contribute to this broader evidence requirement , with the methodological issues evident here being relevant to other trials within the field .


This study sought to determine the utilization and outcomes for radial access for percutaneous coronary intervention ( PCI ) for ST-segment elevation acute myocardial infarction ( STEMI ) in common practice .


Radial access for PCI has been studied considerably , but mostly in clinical trials .


All patients undergoing PCI for STEMI in @ to @ in New York were studied to determine the frequency and the patient-level predictors of radial access .


Differences in in-hospital/@-day mortality between radial and femoral access were also studied .


Radial access increased from @ % in the first quarter of @ to @ % in the last quarter of @ .


Significant independent predictors were higher body surface area , non-Hispanic ethnicity , Caucasian race , stable hemodynamic state , ejection fraction < @ % and @ % onset of STEMI from @to @ h before the index procedure , and peripheral vascular disease .


Mortality was not related to access site after adjustment for covariates ( for radial vs. femoral access , adjusted odds ratio : @ , @ % confidence interval : @ to @ ) , but the radial access site was trending toward lower mortality for the @ hospitals that used it for more than @ % of their patients ( adjusted odds ratio : @ , @ % confidence interval : @ to @ ) .


The use of a radial access site for PCI in STEMI patients increased between @ and @ , but was still infrequent in @ , and was used for lower-risk STEMI patients .


There was no significant difference in mortality by access site , but there was a trend toward a mortality advantage for patients with a radial access site among hospitals that used it relatively frequently .


A recent study compared the efficacy of tenofovir disoproxil fumarate ( TDF ) vs the combination of emtricitabine and TDF ( FTC/TDF ) in patients with lamivudine-resistant chronic hepatitis B who were treated for as long as @ weeks .


We report findings from resistance analyses conducted for this study .


Two hundred eighty patients with chronic hepatitis B virus ( HBV ) infection and lamivudine resistance ( confirmed by INNO-LiPA Multi-DR ) were randomly assigned ( @:@ ) to groups treated with TDF or FTC/TDF .


The HBV reverse transcriptase domain from the polymerase gene from all patients was sequenced at baseline and from @ viremic patients at week @ or early discontinuation .


At screening for the efficacy study , @ % of patients were found to have lamivudine resistance .


Prior exposure to entecavir or entecavir resistance was observed in @ % of patients , and @ % of patients had been previously exposed to adefovir ; @ % were resistant to adefovir .


Only @ patients ( @ % ) qualified for sequence analysis , including @ patient who experienced virologic breakthrough and @ with persistent viremia .


Six of these patients did not have any sequence changes from baseline in HBV reverse transcriptase ( @ % ) , and sequence analysis could not be performed for @ patients ( @ % ) .


In @ patients who qualified for phenotypic analysis ( @ given TDF and @ given FTC/TDF ) , no resistance to TDF was observed .


Neither previous treatment exposure nor resistance to entecavir or adefovir affected viral kinetics .


However , the mean baseline level of HBV DNA was significantly higher in viremic patients than in patients with viral suppression by week @ ( @ log@ IU/mL vs @ log@ IU/mL ; P = @ ) .


No resistance to TDF was detected through @ weeks of treatment in patients with lamivudine-resistant chronic hepatitis B. Prior treatment or resistance to entecavir or adefovir did not affect viral kinetics through @ weeks .


No additional benefit was observed with the addition of emtricitabine vs TDF monotherapy .


ClinicalTrial.gov number : NCT@ .


The impact of educational strategies in the management of adverse treatment effects and drug interactions in adult patients with epilepsy with comorbidities remains undetermined .


The EDU-COM study is a randomised , pragmatic trial investigating the effect of a patient-tailored educational plan in patients with epilepsy with comorbidity .


@ adult patients with epilepsy with chronic comorbidities , multiple-drug therapy and reporting at least one adverse treatment effect and/or drug interaction at study entry were randomly assigned to the educational plan or usual care .


The primary endpoint was the number of patients becoming free from adverse treatment events and/or drug interactions after a @-month follow-up .


The number of adverse treatment events and drug interactions , health-related quality of life ( HRQOL ) summary score changes and the monetary costs of medical contacts and drugs were assessed as secondary outcomes .


The primary endpoint was met by @ % of patients receiving the educational plan versus @ % of those on usual care ( p = @ ) .


The control group reported a significantly higher risk not to meet successfully the primary endpoint at the end of the study : OR ( @ % CI ) of @ ( @ to @ ) .


A separate analysis on drug adverse effects and drug interactions showed that the latter were more sensitive to the effect of educational treatment .


Quality of life and costs were not significantly different in the two groups .


A patient-tailored educational strategy is effective in reducing drug-related problems ( particularly drug interactions ) in epilepsy patients with chronic comorbidities , without adding significant monetary costs .


Registered at ClinicalTrials.gov , identifier NCT@ , ( http://www.clinicaltrials.gov ) .


An emerging field of research describes the role of preoperative health behaviours , known as prehabilitation .


The preoperative period may be a more physically and emotionally salient time to introduce and foster chronic adherence to health behaviours , such as exercise , in patients compared to post-treatment during recovery .


Moreover , physical and psychosocial improvements during the preoperative period may translate into an enhanced recovery trajectory with reduced operative complications and postoperative adverse effects .


No studies have assessed prehabilitation for men with prostate cancer undergoing radical prostatectomy .


This is a multi-centre , pilot randomized control trial conducted at two Canadian urban teaching hospitals .


@ men undergoing radical prostatectomy for prostate cancer with no contraindications to exercise will be recruited and randomized to the prehabiliation program or usual care .


Prehabilitation participants will engage in a preoperative , individualized exercise program including pelvic floor muscle strengthening instructions and a healthy lifestyle guide for men with prostate cancer .


These participants will be asked to engage in @ minutes of home-based , unsupervised , moderate-intensity exercise on @-@ days per week .


Usual care participants will receive the same pelvic floor muscle strengthening instructions and healthy lifestyle guide only .


We will assess the feasibility of conducting an adequately powered trial of the same design via recruitment rate , programmatic adherence/contamination , attrition , and safety .


Estimates of intervention efficacy will be captured through measurements at baseline ( @-@ weeks preoperatively ) , within @ week prior to surgery , and postoperatively at @ , @ , and @ weeks .


Efficacy outcomes include : fatigue , quality of life , urinary incontinence , physical fitness , body composition , aerobic fitness , pain , and physical activity volume .


The primary outcome of this study is to determine the feasibility of conducting a full-scale , randomized controlled trial of prehabilitation versus usual care and to estimate effect sizes that will inform sample size determinations for subsequent trials in this field .


To our knowledge , this is the first study to examine a structured presurgical exercise program for men undergoing radical prostatectomy for prostate cancer .


This trial will advance our understanding of strategies to efficiently and effectively use the preoperative period to optimize postoperative recovery .


Diabetes mellitus ( DM ) is associated with poor outcome after surgery .


The prevalence of DM in hospitalised patients is up to @ % , meaning that the anaesthesiologist will encounter a patient with DM in the operating room on a daily basis .


Despite an abundance of published glucose lowering protocols and the known negative outcomes associated with perioperative hyperglycaemia in DM , there is no evidence regarding the optimal intraoperative glucose lowering treatment .


In addition , protocol adherence is usually low and protocol targets are not simply met .


Recently , incretins have been introduced to lower blood glucose .


The main hormone of the incretin system is glucagon-like peptide-@ ( GLP-@ ) .


GLP-@ increases insulin and decreases glucagon secretion in a glucose-dependent manner , resulting in glucose lowering action with a low incidence of hypoglycaemia .


We set out to determine the optimal intraoperative treatment algorithm to lower glucose in patients with DM type @ undergoing non-cardiac surgery , comparing intraoperative glucose-insulin-potassium infusion ( GIK ) , insulin bolus regimen ( BR ) and GPL-@ ( liragludite , LG ) treatment .


This is a multicentre randomised open label trial in patients with DM type @ undergoing non-cardiac surgery .


Patients are randomly assigned to one of three study arms ; intraoperative glucose-insulin-potassium infusion ( GIK ) , intraoperative sliding-scale insulin boluses ( BR ) or GPL-@ pre-treatment with liraglutide ( LG ) .


Capillary glucose will be measured every hour .


If necessary , in all study arms glucose will be adjusted with an intravenous bolus of insulin .


Researchers , care givers and patients will not be blinded for the assigned treatment .


The main outcome measure is the difference in median glucose between the three study arms at @ hour postoperatively .


We will include @ patients , which gives us a @ % power to detect a @ mmol l ( -@ ) difference in glucose between the study arms .


The PILGRIM trial started in January @ and will provide relevant information on the perioperative use of GLP-@ agonists and the optimal intraoperative treatment algorithm in patients with diabetes mellitus type @ .


Pharmacologic treatment for secondary prevention of coronary heart disease ( CHD ) is critical to prevent adverse clinical outcomes .


In a randomized controlled trial , we compared antiplatelet and statin adherence among patients with CHD who received : ( @ ) text messages ( TM ) for medication reminders and education , ( @ ) educational TM only , or ( @ ) No TM .


A mobile health intervention delivered customized TM for @ days .


We assessed and analyzed medication adherence with electronic monitoring devices -LSB- Medication Event Monitoring System ( MEMS ) -RSB- by one-way ANOVA and Welch tests , two-way TM response rates by t-tests , and self-reported adherence ( Morisky Medication Adherence Scale ) by Repeated Measures ANOVA .


Among @ patients ( @ % male , mean age @ years ) , MEMS revealed patients who received TM for antiplatelets had a higher percentage of correct doses taken ( p = @ ) , percentage number of doses taken ( p = @ ) , and percentage of prescribed doses taken on schedule ( p = @ ) .


TM response rates were higher for antiplatelets than statins ( p = @ ) .


Self-reported adherence revealed no significant differences among groups .


TM increased adherence to antiplatelet therapy demonstrated by MEMS and TM responses .


Feasibility and high satisfaction were established .


Mobile health interventions show promise in promoting medication adherence .


To study the impacts of electroacupuncture ( EA ) on memory impairment after cerebral infarction through the observation of hydrogen proton magnetic resonance spectroscopy ( @H-MRS ) of brain tissue metabolites in the patients of cerebral infarction .


Sixty cases of memory impairment after cerebral infarction were randomized into an observation group and a control group , @ cases in each one .


The conventional rehabilitation training and medication were applied to all the patients .


In the observation group , beside the basic treatment , EA was applied to bilateral Ezhongxian ( MS @ ) , Dingzhongxian ( MS @ ) , Dingniehouxiexian ( MS @ ) , Hegu ( LI @ ) , Taichong ( LR @ ) , Zusanli ( ST @ ) , Taixi ( KI @ ) , Xuanzhong ( GB @ ) and Fengchi ( GB @ ) .


The treatment was given once a day , @ times a week , for @ weeks .


The clinical memory scale was used for the score evaluation before and after treatment in all the patients .


The magnetic resonance image ( MRI ) and @H-MRS scanning were applied to the head .


The ratio of N-acetyl aspartate ( NAA ) and creatine ( Cr ) and the ratio of choline ( Cho ) and Cr were determined in the foci of cerebral infarction .


Eight weeks later , the scores of clinical memory scale were all increased after treatment as compared with those before treatment in the two group ( all P < @ ) .


The ratio of NAA and Cr was increased as compared with that before treatment ( P < @ ) ; the ratio of Cho and Cr was reduced as compared with that before treatment ( P < @ ) .


The changes in the observation group were more obvious than those in the control group ( all P < @ ) .


On the basis of the conventional medication and rehabilitation training , EA improves the metabolism of brain tissue and memory function of the patients .


The efficacy of this therapy is better than that of medication combined with rehabilitation training .


Vasovagal syncope ( VVS ) represents by far the most common cause of syncope as it is diagnosed in around @ % of all patients that come to an emergency department .


Although VVS is not fatal , it can cause an injury .


Even serious injuries are not common , but there are reports of serious injuries of up to @ % .


There are no current studies that demonstrate the effectiveness of any treatment .


Past studies found that an Anti-Gravity suit ( G-suit ) can increase blood pressure and has been reported to prevent orthostatic hypotension effectively in patients with diabetes .


It is possible that the G-suit can prevent VVS .


In the present study , the authors assessed the efficacy of G-suit for vasovagal syncope prevention .


In this open-label , randomized controlled study , we used the Italian tilt protocol , namely @ degree passive tilting followed by @ mg nitroglycerin challenge when the passive phase fails to induce syncope .


If test was positive , then patient was enrolled .


Tilt table test was repeated to compare G-suited and no G-suited to assess efficacy of G-suit for vasovagal syncope prevention .


@ patients were enrolled .


There is no difference between the control group and an experimental group .


In this study there is no cardio-inhibition vasovagal syncope .


Positive tilt table test occurred in @ % of the patients receiving G-suited and @ % in control group ( p @ ) .


G-suit is unable to prevent syncope in patients with positive tilt table test but the result is not statistically significant .


However , the number of patients may be too small .


Hearing-impaired listeners localize sounds better unaided than aided .


Wide dynamic range compression circuits operating independently at each ear in bilateral fittings , and microphone positions of different hearing aid styles , have been cited as a reason .


Two hearing aid features , inter-ear coordinated compression ( IE ) and pinna compensation ( PC ) , were developed to mitigate the compromised aided localization performance .


This study examined the effect of IE and PC on aided localization performance in the horizontal plane with hearing-impaired listeners .


A single-blind , repeated-measures design was used .


A total of @ experienced hearing aid users with bilaterally symmetrical sensorineural hearing loss who had previously participated in localization training were evaluated .


Localization performance was measured using @ loudspeakers spaced @ apart on the horizontal plane .


Aided performance was evaluated using a behind-the-ear hearing aid at four settings : omnidirectional microphone ( Omni ) , Omni microphone with the PC feature , Omni microphone with IE , and Omni microphone with the PC feature and IE together .


In addition , unaided localization performance was measured .


Significant improvement in the localization accuracy was measured for sounds arriving from the back when comparing the PC with the Omni conditions .


The use of IE reduced the magnitude of errors for some listeners for sounds originating from @ .


The average reduction in the errors was @ .


This study confirmed that the use of the PC feature improved localization for sounds arriving from behind the listener .


The use of IE may improve localization for some listeners for sounds arriving from the sides .


On the Internet , people share personal experiences as well as facts and objective information .


This also holds true for the exchange of health-related information in a variety of Internet forums .


In online discussions about health topics , both fact-oriented and strongly personal contributions occur on a regular basis .


In this field experiment , we examined in what way the particular type of contribution ( ie , factual information vs personal experiences ) has an impact on the subsequent communication in health-related Internet forums .


For this purpose , we posted parallelized queries to @ comparable Internet forums ; queries were identical with regard to the information contained but included either fact-oriented descriptions or personal experiences related to measles vaccination .


In the factual information condition , we posted queries to the forums that contained the neutral summary of a scientific article .


In the personal experiences condition , we posted queries to the forums that contained the same information as in the first condition , but were framed as personal experiences


We found no evidence that personal experiences evoked more responses ( mean @ , SD @ ) from other members of the Internet forums than fact-oriented contributions ( mean @ , SD @ , t@ = @ , P = @ ) .


But personal experiences elicited emotional replies ( mean @ , SD @ ) from other users to a greater extent than fact-oriented contributions ( mean @ , SD @ , t@ = @ , P < @ ) .


We suggest that personal experiences elicited more emotional replies due to the process of emotional anchoring of people 's own style of communication .


We recommend future studies should aim at testing the hypotheses with more general and with less emotionally charged topics , constructing different fact-oriented posts , and examining additional potential factors of influence such as personality factors or particular communication situations .


To test the hypothesis that trained nurse endoscopists are not inferior to medical endoscopists in finding adenomas during colonoscopy .


This is a prospective , randomised , single-blind , non-inferiority study comparing nurses with medical endoscopists in performing screening colonoscopy .


The nurse endoscopists had been trained according to the British Joint Advisory Group on GI Endoscopy curriculum and had completed at least @ colonoscopic procedures prior to the study .


The primary endpoint was the adenoma detection rate .


Secondary endpoints included the caecal intubation rate , intubation time , complication rate , patient pain and satisfaction scores .


We enrolled and analysed a total of @ patients over a @-month period .


At least one adenoma was found in @ ( @ % ) of @ patients by nurse endoscopists and @ ( @ % ) of @ patients by medical endoscopists and a proportion difference of +@ % compared with the medical endoscopists ( @ % CI @ % to @ % ) .


The withdrawal time was , however , significantly longer among nurses ( @ vs @ s , p < @ ) .


After adjusting for differences in a regression analysis , colonoscopy by nurses was associated with a lower adenoma detection rate ( OR @ : @ % CI @ to @ ) .


Nurse endoscopists had a lower caecal intubation rate ( @ % vs @ % ) , received better pain and satisfaction scores and had a high rate of patient acceptance .


In this pragmatic trial , nurses can perform screening colonoscopy but require a longer procedural time to achieve a comparable adenoma detection rate as medical endoscopists .


Buprenorphine opioid agonist treatment ( OAT ) has established efficacy for treating opioid dependency among persons seeking addiction treatment .


However , effectiveness for out-of-treatment , hospitalized patients is not known .


To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT , increase sustained engagement in OAT , and decrease illicit opioid use at @ months after hospitalization .


From August @ , @ , through October @ , @ , a total of @ hospitalized , opioid-dependent patients in a general medical hospital were identified .


Of these , @ did not meet eligibility criteria .


A total of @ eligible patients consented to participation in the randomized clinical trial .


Of these , @ completed the baseline interview and were assigned to the detoxification ( n = @ ) or linkage ( n = @ ) group .


Five-day buprenorphine detoxification protocol or buprenorphine induction , intrahospital dose stabilization , and postdischarge transition to maintenance buprenorphine OAT affiliated with the hospital 's primary care clinic ( linkage ) .


Entry and sustained engagement with buprenorphine OAT at @ , @ , and @ months ( medical record verified ) and prior @-day use of illicit opioids ( self-report ) .


During follow-up , linkage participants were more likely to enter buprenorphine OAT than those in the detoxification group ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- , P < @ ) .


At @ months , @ linkage participants ( @ % ) and @ detoxification participants ( @ % ) were receiving buprenorphine OAT ( P = @ ) .


Compared with those in the detoxification group , participants randomized to the linkage group reported less illicit opioid use in the @ days before the @-month interview ( incidence rate ratio ,@ ; @ % CI , @-@ @ ; P < @ ) in an intent-to-treat analysis .


Compared with an inpatient detoxification protocol , initiation of and linkage to buprenorphine treatment is an effective means for engaging medically hospitalized patients who are not seeking addiction treatment and reduces illicit opioid use @ months after hospitalization .


However , maintaining engagement in treatment remains a challenge .


Ureteroscopy is central to the surgical management of ureteral stones .


Fluoroscopy is conventionally used for intraoperative guidance , although there is growing effort to decrease the exposure of patients and staff to ionizing radiation .


We developed a radiation-free approach to ureteroscopy using ultrasound guidance to manage ureteral stones .


To our knowledge we present the first randomized trial to study its safety and efficacy .


This single center , randomized clinical trial from @ to @ enlisted patients who presented with symptomatic ureteral stones @ mm or less without a significant ipsilateral stone burden .


Patients were randomly assigned to ultrasound or fluoroscopic guided ureteroscopy after temporizing ureteral stent placement .


Intraoperative ultrasound guidance was performed using real-time imaging with the transducer placed at the patient flank to visualize the collecting system of the ipsilateral kidney .


We compared operative time , stone size , stone-free status and complication rates between the @ groups .


A total of @ patients were enrolled in study with @ per arm .


There was no difference in stone size ( @ vs @ mm ) , patient age ( @ vs @ years ) or body mass index ( @ vs @ kg/m ( @ ) ) in the test group compared to controls .


The ultrasound guidance cohort showed no significant difference in the stone-free rate ( @ % vs @ % ) or the complication rate ( @ % vs @ % ) compared to controls .


Operative time was no longer in the ultrasound guidance cohort .


In this feasibility study we found that ureteral stones may be definitively managed in a timely , effective and safe fashion without ionizing radiation in the general population using this novel technique of ultrasound guided ureteroscopy .


Elotuzumab , an immunostimulatory monoclonal antibody targeting signaling lymphocytic activation molecule F@ ( SLAMF@ ) , showed activity in combination with lenalidomide and dexamethasone in a phase @b-@ study in patients with relapsed or refractory multiple myeloma .


In this phase @ study , we randomly assigned patients to receive either elotuzumab plus lenalidomide and dexamethasone ( elotuzumab group ) or lenalidomide and dexamethasone alone ( control group ) .


Coprimary end points were progression-free survival and the overall response rate .


Final results for the coprimary end points are reported on the basis of a planned interim analysis of progression-free survival .


Overall , @ patients were assigned to the elotuzumab group and @ to the control group .


After a median follow-up of @ months , the rate of progression-free survival at @ year in the elotuzumab group was @ % , as compared with @ % in the control group ; at @ years , the rates were @ % and @ % , respectively .


Median progression-free survival in the elotuzumab group was @ months , versus @ months in the control group ( hazard ratio for progression or death in the elotuzumab group , @ ; @ % confidence interval , @ to @ ; P < @ ) .


The overall response rate in the elotuzumab group was @ % , versus @ % in the control group ( P < @ ) .


Common grade @ or @ adverse events in the two groups were lymphocytopenia , neutropenia , fatigue , and pneumonia .


Infusion reactions occurred in @ patients ( @ % ) in the elotuzumab group and were grade @ or @ in @ patients .


Patients with relapsed or refractory multiple myeloma who received a combination of elotuzumab , lenalidomide , and dexamethasone had a significant relative reduction of @ % in the risk of disease progression or death .


( Funded by Bristol-Myers Squibb and AbbVie Biotherapeutics ; ELOQUENT-@ ClinicalTrials.gov number , NCT@ . )


Invasive fungal infections are very severe infections associated with high mortality rates , despite the availability of new classes of antifungal agents .


Based on pathophysiological mechanisms and limited pre-clinical and clinical data , adjunctive immune-stimulatory therapy with interferon-gamma ( IFN - ) may represent a promising candidate to improve outcome of invasive fungal infections by enhancing host defence mechanisms .


In this open-label , prospective case series , we describe eight patients with invasive Candida and/or Aspergillus infections who were treated with recombinant IFN - ( rIFN - , @ g s.c. , thrice a week ) for @ weeks in addition to standard antifungal therapy .


Recombinant IFN - treatment in patients with invasive Candida and/or Aspergillus infections partially restored immune function , as characterized by an increased HLA-DR expression in those patients with a baseline expression below @ % , and an enhanced capacity of leukocytes from treated patients to produce proinflammatory cytokines involved in antifungal defence .


The present study provides evidence that adjunctive immunotherapy with IFN - can restore immune function in fungal sepsis patients , warranting future clinical studies to assess its potential clinical benefit .


To assess the feasibility of using an ultra-low dose ( @ mmol/kg of body weight -LSB- BW -RSB- ) of high relaxivity contrast agent for late gadolinium enhancement ( LGE ) imaging in patients with acute myocardial infarction ( AMI ) .


@ consecutive patients ( mean age , @ @ years ) with ST-segment elevation AMI underwent two randomized cardiac magnetic resonance studies ( exam intervals between @ and @h ) on a @ T unit during the first week after the event using gadobenate dimeglumine ( Gd-BOPTA ) at the dose of @ mmol/kg BW ( standard dose or SD group ) and @ mmol/kg BW ( half dose or HD group ) .


Image quality was qualitatively assessed .


Quantitative analysis of LGE were performed by measuring signal intensity ( SI ) , signal-to-noise ratio ( SNR ) in the infarcted myocardium ( IM ) , non-infarcted myocardium ( N-IM ) and left ventricular cavity ( LVC ) in images acquired at @ , @ , @ , @ , @ and @ min after administration of Gd-BOPTA using both contrast media protocol .


Contrast-to-noise ratio ( CNR ) between IM and N-IM ( CNR IM/N-IM ) and between IM and LVC ( CNR IM/LVC ) were also quantified for each time point .


Moreover the extent of infarcted myocardium was measured .


@ LGE images were evaluated for each dose group .


Quality score was significantly higher for SD at @ , @ and @ min ( @ < p < @ ) and for HD at @ min ( p = @ ) .


SNR has been higher in the SD group compared to the HD group even though not statistically significant at any time-point for both IM ( SD vs. HD : @ @ vs. @ @ ; @ < p < @ ) and N-IM ( SD vs. HD : @ @ vs. @ @ ; @ < p < @ ) .


LVC SNR was significantly higher with SD at @ min ( p = @ ) , @ min ( p = @ ) and @ min ( p = @ ) .


CNR between the IM and N-IM was significantly higher using SD compared to HD ( @ @ vs. @ @ ; @ < p < @ ) at @ , @ and @ min .


No significant differences in CNR IM/LVC were noted for HD acquired @ min after CM administration compared to SD acquired at @ ( p = @ ) , @ ( p = @ ) and @ ( p = @ ) min , and between HD at @ min compared to SD acquired at @ min ( p = @ ) and @ min ( p = @ ) .


Good correlation between SD and HD ( @ < r ( @ ) < @ , p < @ ) was found at all time-points in the measuring of IA .


The use of a @ mmol/kg dose of gadobenate dimeglumine is feasible for LGE imaging of acute MI and the best image quality is obtained at @ min after contrast administration .


It could be beneficial in patient with renal failure and a solution to improve the identification of subendocardial infarction reducing examination time , costs and total gadolinium load .


However , the standard dose of @ mmol/kg provides overall better image quality , with the best performance obtained at the delay of @ min or more after Gd-BOPTA administration , and it should be routinely preferred .


To evaluate the effects of olive oil and flaxseed oil compared with mineral oil for the treatment of constipation in patients undergoing hemodialysis .


A @-week , double-blind , randomized , and controlled trial was conducted .


Fifty constipated patients ( @ % male , @years ) diagnosed by the Rome III criteria were randomly assigned to receive mineral oil ( control group ; n = @ ) , olive oil ( n = @ ) , or flaxseed oil ( n = @ ) .


The initial oil dose was @mL/day , and adjustments during the follow-up could be made as needed .


The impact of the intervention was assessed by the Rome III criteria scores .


The most frequent symptoms of constipation evaluated by the Roma III criteria at baseline were comparable among the groups and included `` incomplete evacuation '' ( @ % ) , `` lumpy or hard stools , '' ( @ % ) and `` anorectal obstruction '' ( @ % ) .


The Rome III score improved significantly in patients receiving mineral oil ( @ to @ ; P < @ ) , olive oil ( @ to @ ; P = @ ) , and flaxseed oil ( @ to @ ; P < @ ) , with no significant group-by-time interaction ( P = @ ) .


The scores of @ from @ constipation symptoms reduced similarly in the mineral oil and olive oil groups , whereas only the frequency of evacuation and the consistency of stools improved in the flaxseed oil group .


We demonstrated that the daily use of olive oil or flaxseed oil was as effective as mineral oil in the treatment of constipation in patients undergoing hemodialysis .


The growing prevalence of health care ethics consultation ( HCEC ) services in the U.S. has been accompanied by an increase in calls for accountability and quality assurance , and for the debates surrounding why and how HCEC is evaluated .


The objective of this study was to evaluate the effectiveness of HCEC as indicated by several novel outcome measurements in East Asian medical encounters .


Patients with medical uncertainty or conflict regarding value-laden issues , and requests made by the attending physicians or nurses for HCEC from December @ , @ to April @ , @ were randomly assigned to the usual care group ( UC group ) and the intervention group ( HCEC group ) .


The patients in the HCEC group received HCEC conducted by an individual ethics consultant .


Data analysis was based on the intention-to-treat principle .


Mann-Whitney test and Chi-squared test were used depending on the scale of measurement .


Thirty-three patients ( @ % ) were randomly assigned to the HCEC group and @ patients were randomly assigned to the UC group .


Among the @ patients in the HCEC group , two ( @ % ) of them ultimately did not receive a HCEC service .


Among the @ patients in the UC group , four ( @ % ) of them received a HCEC service .


The survival rate at hospital discharge did not differ between the two groups .


Patients in the HCEC group showed significant reductions in the entire ICU stay and entire hospital stay .


HCEC significantly facilitated achieving the goal of medical care ( p < @ ) .


Furthermore , patients in the HCEC group had a shorter ICU stay and shorter hospital stay after the occurrence of medical uncertainty or conflict regarding value-laden issues than those in the UC group .


Our findings demonstrated that HCEC were associated with reduced consumption of medical resources as indicated by shorter entire ICU stay , entire hospital stay , and shorter ICU and hospital stay after the occurrence of the medical uncertainty or conflict regarding value-laden issues .


This study also showed that HCEC facilitated achieving a consensus regarding the goal of medical care , which conforms to the goal of HCEC .


The methods of evaluating endoscopic mucosal findings and the definition of mucosal healing in inflammatory bowel disease have not been standardized .


To examine a third-party central review of colonic mucosal evaluations .


A double-blind , placebo-controlled , parallel-group trial was performed for @weeks , which involved continuous administration of a @-g mesalazine suppository to @ patients with mild to moderate ulcerative colitis and active rectal inflammatory findings .


Mucosal findings were evaluated by using a @-grade score ( @ , @ , @ , @ ) .


Reviews by attending physicians were considered the primary evaluations .


Concurrently , a central review committee of @ gastroenterologists served as the third party .


The endoscopic remission induction rate from the attending physicians ' evaluations was @ % in the mesalazine suppository group and @ % in the placebo suppository group , whereas the respective rates from the central review committee were @ % and @ % .


However , there was a difference of @ percentage points between the remission induction rates of the placebo group found by the two groups of raters .


Differences in the evaluations of mucosal finding scores were also found among the third-party reviewers .


The evaluations of the attending physicians were consistent with those of the central review committee in showing the effectiveness of mesalazine suppository through the index of mucosal healing .


However , differences were observed among the raters in their evaluations of mucosal finding scores .


Therefore , standardizing evaluation criteria and improving review methods for mucosal findings would enable the more effective use of third-party central reviews in clinical drug trials .


Poor and underserved women face barriers in receiving timely and appropriate breast cancer care .


Patient navigators help individuals overcome these barriers , but little is known about whether patient navigation improves quality of care .


The purpose of this study is to examine whether navigated women with breast cancer are more likely to receive recommended standard breast cancer care .


Women with breast cancer who participated in the national Patient Navigation Research Program were examined to determine whether the care they received included the following : initiation of antiestrogen therapy in patients with hormone receptor-positive breast cancer ; initiation of postlumpectomy radiation therapy ; and initiation of chemotherapy in women younger than age @ years with triple-negative tumors more than @ cm .


This is a secondary analysis of a multicenter quasi-experimental study funded by the National Cancer Institute to evaluate patient navigation .


Multiple logistic regression was performed to compare differences in receipt of care between navigated and non-navigated participants .


Among participants eligible for antiestrogen therapy , navigated participants ( n = @ ) had a statistically significant higher likelihood of receiving antiestrogen therapy compared with non-navigated controls ( n = @ ; odds ratio -LSB- OR -RSB- , @ ; P = @ ) in a multivariable analysis .


Among the participants eligible for radiation therapy after lumpectomy , navigated participants ( n = @ ) were no more likely to receive radiation ( OR , @ ; P = @ ) than control participants ( n = @ ) .


We demonstrate that navigated participants were more likely than non-navigated participants to receive antiestrogen therapy .


Future studies are required to determine the full impact patient navigation may have on ensuring that vulnerable populations receive quality care .


Chemoradioimmunotherapy of patients with pancreatic adenocarcinoma from the CapRI trial did not show any benefit of interferon - in addition to a @-fluorouracil ( @FU ) - based treatment .


The aim of this study was to identify immunological parameters in patients from this trial to be used for predictive and/or prognostic purposes .


The following methods were used : tumour immunohistology , FACS analyses , cytokine measurement , as well as cytotoxicity and ELIspot .


Immunological parameters were correlated with patients ' survival using the Kaplan-Meier method .


Irrespective of therapy type , high lymphocyte accumulation in tumours and frequencies of NK cells and effector ( eff ) CD@ ( + ) T cells in peripheral blood of the patients were associated with patients ' survival .


Amount of CD@ ( + ) and effector-memory CD@ ( + ) blood lymphocytes , expression of CD@ and interleukin ( IL ) -@ serum level showed a predictive value for chemoradioimmunotherapy .


Tumoural accumulation of CD@ ( + ) and CD@ ( + ) cells was predictive for outcome of chemotherapy alone .


Besides , we identified the frequencies of CD@ ( + ) lymphocytes , effCD@ ( + ) T cells and NK cells in the peripheral blood of the patients , and IL-@ amount in serum , to be predictive values for @FU-based chemotherapy .


Immunological parameters , identified in this trial as possible markers , may be of interest in personalized medicine towards the improvement of the treatment and prognosis of pancreatic carcinoma patients .


Patient-specific instrumentation in TKA has the proposed benefits of improving coronal and sagittal alignment and rotation of the components .


In contrast , the literature is inconsistent if the use of patient-specific instrumentation improves alignment in comparison to conventional instrumentation .


Depending on the manufacturer , patient-specific instrumentation is based on either MRI or CT scans .


However , it is unknown whether one patient-specific instrumentation approach is more accurate than the other and if there is a potential benefit in terms of reduction of duration of surgery .


We compared the accuracy of MRI - and CT-based patient-specific instrumentation with conventional instrumentation and with each other in TKAs .


The three approaches also were compared with respect to validated outcomes scores and duration of surgery .


A randomized clinical trial was conducted in which @ patients were enrolled and divided into three groups : CT-based , MRI-based patient-specific instrumentation , and conventional instrumentation .


The groups were not different regarding age , male/female sex distribution , and BMI .


In all groups , coronal and sagittal alignments were measured on postoperative standing long-leg and lateral radiographs .


Component rotation was measured on CT scans .


Clinical outcomes ( Knee Society and WOMAC scores ) were evaluated preoperatively and at a mean of @ months postoperatively and the duration of surgery was analyzed for each patient .


MRI - and CT-based patient-specific instrumentation groups were first compared with conventional instrumentation , the patient-specific instrumentation groups were compared with each other , and all three approaches were compared for clinical outcome measures and duration of surgery .


Compared with conventional instrumentation MRI - and CT-based patient-specific instrumentation showed higher accuracy regarding the coronal limb axis ( MRI versus conventional , @ -LSB- range , @-@ -RSB- versus @ -LSB- range , @-@ -RSB- , p < @ ; CT versus conventional , @ -LSB- range , @-@ -RSB- versus @ -LSB- range , @-@ -RSB- , p = @ ) , femoral rotation ( MRI versus conventional , @ -LSB- range , @-@ -RSB- versus @ -LSB- range , @-@ -RSB- , p < @ ; CT versus conventional , @ -LSB- range , @-@ -RSB- versus @ -LSB- range , @-@ -RSB- , p < @ ) , and tibial slope ( MRI versus conventional , @ -LSB- range , @-@ -RSB- versus @ -LSB- range , @-@ -RSB- , p < @ ; CT versus conventional , @ -LSB- range , @-@ -RSB- versus @ -LSB- range , @-@ -RSB- , p < @ ) , but the differences were small .


Furthermore , MRI-based patient-specific instrumentation showed a smaller deviation in the postoperative coronal mechanical limb axis compared with CT-based patient-specific instrumentation ( MRI versus CT , @ -LSB- range , @-@ -RSB- versus @ -LSB- range , @-@ -RSB- , p = @ ) , while there was no difference in femoral rotation or tibial slope .


Although there was a significant reduction of the duration of surgery in both patient-specific instrumentation groups in comparison to conventional instrumentation ( MRI versus conventional , @ minutes -LSB- range , @-@ minutes -RSB- versus @ minutes -LSB- range , @-@ minutes -RSB- , p < @ ; CT versus conventional , @ minutes -LSB- range , @-@ minutes -RSB- versus @ minutes -LSB- range , @-@ minutes -RSB- , p < @ ) , there were no differences in the postoperative Knee Society pain and function and WOMAC scores among the groups .


Although this study supports that patient-specific instrumentation increased accuracy compared with conventional instrumentation and that MRI-based patient-specific instrumentation is more accurate compared with CT-based patient-specific instrumentation regarding coronal mechanical limb axis , differences are only subtle and of questionable clinical relevance .


Because there are no differences in the long-term clinical outcome or survivorship yet available , the widespread use of this technique can not be recommended .


To determine whether Zinc supplementation could reduce relapse rate in children with nephrotic syndrome .


Randomized-controlled trial .


National Institute of Child-Health and The Kidney Centre , Karachi , from January @ to June @ .


Sixty nephrotic children aged @ - @ years were selected .


Baseline data including age , number of infections and relapses during pre and post study one year were recorded .


Randomization was done to divide into Zinc group ( Zg ) to receive Zinc versus placebo ( Pg ) for @ months .


Relapses and infections were treated with standard therapy .


T-test and chi-square tests were used to compare the mean values and proportions respectively with significance at p < @ .


Among @ children , @ completed trial ( Zg = @ , Pg = @ ) .


Forty ( @ % ) were males and @ ( @ % ) females .


Mean age , pre study relapses and Zinc level in the two groups were similar .


Overall , infections and relapses were observed in @ ( @ % ) and @ cases ( @ % ) respectively .


There was no significant difference in frequency of infections and mean infection rate in Zg ( @ , @ % and @ @ ) compared to Pg ( @ , @ % and @ @ , p = @ ) .


Relapses occurred in @ ( @ % ) in Zg compared to @ ( @ % ) in Pg which was not significant ( p = @ ) .


Mean infection and relapse rate per patient per year ( PPPY ) in Zg was @ @ and @ @ compared to @ @ and@ @ @ in Pg respectively ( p = @ , @ ) .


Pre study relapses in two groups were similar ( Zg vs. Pg = @ vs. @ % ) whereas post study relapses in Zg were lower ( @ , @ % ) compared to Pg ( @ , @ % ) .


Post study mean relapse rate in Zg was @ @ PPPY compared to @ @ in pre study ( p = @ ) .


In Pg , post study mean relapse rate PPPY was @ @ compared to @ @ in pre study period ( p = @ ) .


Relapse rate reduction was @ % after Zinc supplementation compared to @ % reduction in placebo .


Metallic taste was observed in @ % of cases .


Zinc supplementation was helpful in reducing relapses in nephrotic syndrome .


To compare two systems of arterial catheters maintenance in postoperative pediatric surgery using intermittent or continuous infusion of heparin solution and to analyze adverse events related to the site of catheter insertion and the volume of infused heparin solution .


Randomized control trial with @ patients selected for continuous infusion group ( CIG ) and intermittent infusion group ( IIG ) .


The variables analyzed were : type of heart disease , permanence time and size of the catheter , insertion site , technique used , volume of heparin solution and adverse events .


The descriptive variables were analyzed by Student 's t-test and the categorical variables , by chi-square test , being significant p < @ .


The median age was @ ( @-@ ) months , and @ ( @ % ) were females .


No significant differences between studied variables were found , except for the volume used in CIG ( @ mL/@ hours ) when compared to IIG ( @ mL/@ hours ) with p < @ .


The continuous infusion system and the intermittent infusion of heparin solution can be used for intra-arterial catheters maintenance in postoperative pediatric surgery , regardless of patient 's clinical and demographic characteristics .


Adverse events up to the third postoperative day occurred similarly in both groups .


However , the intermittent infusion system usage in underweight children should be considered , due to the lower volume of infused heparin solution -LSB- ClinicalTrials.gov Identifier : NCT@ -RSB- .


In the double-blind placebo-controlled Fenofibrate Intervention and Event Lowering in Diabetes trial ( n = @,@ ) , fenofibrate reduced major cardiovascular events in type @ diabetes .


Sex-related differences in fenofibrate response could be clinically relevant and were pre-specified analyses .


Women ( n = @,@ ) and men ( n = @,@ ) with type @ diabetes not using statins were assigned fenofibrate ( @mg/day ) or placebo for @years .


Effects on lipoproteins and total cardiovascular events were evaluated by sex .


Baseline total , LDL - , HDL - and non-HDL cholesterol and apolipoproteins A-I and B differed between sexes , and these and triacylglycerol levels improved with fenofibrate in both sexes ( all p < @ ) .


Fenofibrate reduced total , LDL - and non-HDL cholesterol and apolipoprotein B more in women ( all p < @ ) , independent of menopausal status and statin uptake .


Adjusted for covariates , fenofibrate reduced total cardiovascular outcomes ( cardiovascular death , fatal and non-fatal stroke and carotid and coronary revascularisation ) by @ % in women ( @ % CI @ % , @ % ; p = @ ) and @ % in men ( @ % CI -@ % , @ % ; p = @ ) with no treatment-by-sex interaction ( p > @ ) .


In patients with high triacylglycerol levels and low HDL-cholesterol , fenofibrate reduced total cardiovascular outcomes by @ % ( @ % CI -@ % , @ % ) in women and @ % ( @ % CI @ % , @ % ) in men , with no treatment-by-sex interaction ( p > @ ) .


Fenofibrate improved the lipoprotein profile more in women than men .


Cardiovascular event reductions with fenofibrate were consistently similar in women and men , both overall and among those with low HDL-cholesterol and high triacylglycerol levels .


These data provide reassurance about fenofibrate efficacy in women and men .


Both sexes with type @ diabetes should be considered for fenofibrate therapy for cardioprotection .


We aimed to determine with this randomized , triple-masked , placebo-controlled study if benefits are afforded by adding a multiple-day , ambulatory , continuous ropivacaine paravertebral nerve block to a single-injection ropivacaine paravertebral block after mastectomy .


Preoperatively , @ subjects undergoing unilateral ( n = @ ) or bilateral ( n = @ ) mastectomy received either unilateral or bilateral paravertebral perineural catheter ( s ) , respectively , inserted between the third and fourth thoracic transverse process ( es ) .


All subjects received an initial bolus of ropivacaine @ % ( @ mL ) via the catheter ( s ) .


Subjects were randomized to receive either perineural ropivacaine @ % or normal saline using portable infusion pump ( s ) -LSB- @ mL/h basal ; @ mL reservoir ( s ) -RSB- .


Subjects remained hospitalized for at least @ night and were subsequently discharged home where the catheter ( s ) were removed on postoperative day ( POD ) @ .


Subjects were contacted by telephone on PODs @ , @ , @ , and @ .


The primary end point was average pain ( scale , @-@ ) queried on POD @ .


Average pain queried on POD @ for subjects receiving perineural ropivacaine ( n = @ ) was a median ( interquartile ) of @ ( @-@ ) , compared with @ ( @-@ ) for subjects receiving saline ( n = @ ; @ % confidence interval difference in medians , -@ to -@ ; P = @ -RSB- .


During this same period , subjects receiving ropivacaine experienced a lower severity of breakthrough pain ( @ -LSB- @-@ -RSB- vs @ -LSB- @-@ -RSB- ; P = @ ) as well .


As a result , subjects receiving perineural ropivacaine experienced less pain-induced physical and emotional dysfunction , as measured with the Brief Pain Inventory ( lower score = less dysfunction ) : @ ( @-@ ) versus @ ( @-@ ) for subjects receiving perineural saline ( P = @ ) .


For the subscale that measures the degree of interference of pain on @ domains , such as general activity and relationships , subjects receiving perineural saline reported a median score @ times higher ( more dysfunction ) than those receiving ropivacaine ( @ -LSB- @-@ -RSB- vs @ -LSB- @-@ -RSB- ; P = @ ) .


In contrast , after infusion discontinuation , there were no statistically significant differences detected between treatment groups .


After mastectomy , adding a multiple-day , ambulatory , continuous ropivacaine infusion to a single-injection ropivacaine paravertebral nerve block results in improved analgesia and less functional deficit during the infusion .


However , no benefits were identified after infusion discontinuation .


We hypothesised that short-term application of bi-level nasal continuous positive airway pressure CPAP ( SiPAP ) compared with conventional nasal CPAP ( nCPAP ) at the same mean airway pressure in infants with persistent oxygen need recovering from respiratory distress syndrome would improve CO@ removal with no change in oxygen requirement .


Non-blinded , randomised , observational four-period crossover study .


Level III NICU ; low-birthweight infants requiring CPAP and oxygen while recovering from respiratory distress syndrome .


Infants requiring nasal CPAP for > @h prior to study enrolment , and fraction of inspired oxygen requirement ( FiO@ ) of @-@ @ , were randomised to either nCPAP or SiPAP .


A crossover design with four @ h treatment periods was used such that each infant received both treatments twice .


Oxygen saturations ( SaO@ ) , transcutaneous CO@ ( tcCO@ ) and vital signs were monitored continuously .


Polysomnographic recordings were analysed for apnoea , bradycardia and oxygen desaturation .


Twenty low-birthweight infants receiving @ % supplemental oxygen on CPAP of @ cm H@O were studied at an average of @days of age ( @days , SD ) .


There were no differences in tcCO@ or other physiological parameters except mean blood pressure , which was lower during nCPAP ( @ vs @ mmHg ; SD ; p < @ ) .


No differences in short or prolonged apnoea , bradycardia or significant desaturation events were observed .


At similar mean airway pressures , SiPAP does not improve CO@ removal , oxygenation or other studied physiological parameters with the exception of mean blood pressure , which was not clinically significant .


Our goal was to develop and validate , based on theoretical and empirical knowledge , the Pain Assessment Checklist for Seniors with Limited Ability to Communicate ( PACSLAC-II ) , a shorter tool that would improve on the PACSLAC , while addressing limitations of the original version .


The PACSLAC was revised based on the relevant clinical and theoretical literature .


Psychometric properties and clinical utility of the resulting @-item PACSLAC-II were examined .


Specifically , the PACSLAC-II was used to assess pain based on video footage of long-term care ( LTC ) residents with dementia undergoing painful procedures as part of routine care .


Its ability to discriminate pain from non-pain-related states was compared with that of preexisting pain assessment tools using archival data .


A second phase involved the use of the PACSLAC and PACSLAC-II by LTC staff to solicit feedback from health care providers .


Mixed-methods analysis of this feedback was conducted .


The PACSLAC-II demonstrated satisfactory reliability , excellent validity , and ability to differentiate between pain and nonpain states .


The PACSLAC-II also accounted for unique variance in differentiating between pain and nonpain states , even after controlling for the preexisting tools combined , including the PACSLAC .


The PACSLAC-II was also preferred by many LTC nurses and care aides , because of its length and condensed nature , which was thought to facilitate documentation and greater efficiency in pain management .


Findings indicate that the empirical and theoretically driven revisions to the PACSLAC led to improved ability to differentiate between pain and nonpain states , while retaining its clinical utility .


The lipid layer plays a major role in limiting evaporation of the tear film .


Based on interference phenomena , there is a test directed to lipid layer pattern ( LLP ) evaluation , but is affected by subjective interpretation of the patterns .


The aim of this study is to compare the LLP evaluation between two experienced observers on a group of healthy patients .


Furthermore , observers re-evaluated the same images to check their individual repeatability .


LLP was examined using a Tearscope-plus ( Keeler , Windsor , UK ) attached to a slit lamp .


Tear film was recorded by a Topcon DV-@ digital camera video and LLP images were captured .


This yielded @ LLP images that were categorized ( based on Guillon 's scheme ) by two expert observers in two sessions separated by one month .


Interobserver repeatability and intraobserver repeatability between both sessions were studied by using Cohen 's kappa coefficient .


Comparing LLP categorization between both observers , Cohen 's kappa coefficient was @ and @ for first and second session , respectively .


When comparing LLP categorization by the same observer between both sessions , Cohen 's kappa coefficient was @ and @ for Observer @ and Observer @ , respectively .


These results indicate substantial correlation in all cases .


The most frequent misinterpretations were between open and closed meshwork and Wave and closed meshwork patterns .


Although substantial correlation was found between categorizations of experienced observers , misinterpretation of the patterns may appear even in the same observer .


Some misinterpretations between adjacent patterns could be palliated by including intermediate patterns between those categories .


Estrogen-based hormone therapy ( HT ) attenuates abdominal fat gain after menopause , but whether HT improves abdominal fat loss during weight loss is unknown .


It was hypothesized that HT or a selective estrogen receptor modulator ( raloxifene ) would augment reductions in abdominal visceral fat during weight loss when compared to placebo , potentially increasing improvements in glucose tolerance and lipid profile .


Healthy postmenopausal women ( n = @ ; age @-@ yr ) underwent a @-month weight-loss ( primarily exercise ) intervention with randomization to raloxifene ( @ mg/d ) , HT ( conjugated estrogens , @ mg/d ) , or placebo .


Outcomes were change in total and abdominal ( visceral and subcutaneous ) fat mass , lipid profile , and fasting and post-challenge glucose and insulin .


Neither HT nor raloxifene augmented loss of total or abdominal fat mass during exercise-induced weight loss when compared with placebo .


Weight loss-induced improvements in risk factors were similar among the three groups , except for a greater reduction in fasted glucose in the HT group ( difference in change -LSB- @ % CI -RSB- from placebo ; -@ -LSB- -@ , -@ -RSB- ) and greater reductions in LDL ( -@ -LSB- -@ , -@ -RSB- ) and increases in HDL ( @ -LSB- @ , @ -RSB- ) in both treatment groups .


Postmenopausal HT and raloxifene did not increase abdominal fat loss during weight loss , but did improve some cardiometabolic outcomes .


A subset analysis of the randomised , phase @ , MDS-@ study to evaluate outcomes in patients with International Prognostic Scoring System ( IPSS ) - defined Low - / Intermediate ( Int ) -@ - risk myelodysplastic syndromes ( MDS ) with isolated del ( @q ) .


Patients received lenalidomide @mg/d ( days @-@ ; n = @ ) or @mg/d ( days @-@ ; n = @ ) on @-d cycles or placebo ( n = @ ) .


From the placebo and lenalidomide @mg groups , @ % and @ % of patients , respectively , crossed over to lenalidomide @ or @mg at @wk , respectively .


Rates of red blood cell-transfusion independence ( RBC-TI ) @d were higher in the lenalidomide @mg ( @ % ; P < @ ) and @mg ( @ % ; P = @ ) groups vs. placebo ( @ % ) .


Cytogenetic response rates ( major + minor responses ) were @ % ( P < @ ) , @ % ( P = @ ) and @ % , respectively .


Two-year cumulative risk of acute myeloid leukaemia progression was @ % , @ % and @ % in the lenalidomide @mg , @mg , and placebo groups , respectively .


In a @-month landmark analysis , overall survival was longer in lenalidomide-treated patients with RBC-TI @d vs. non-responders ( P = @ ) .


The most common grade @-@ adverse event was myelosuppression .


These data support the clinical benefits and acceptable safety profile of lenalidomide in transfusion-dependent patients with IPSS-defined Low - / Int-@-risk MDS with isolated del ( @q ) .


Weight loss studies were conducted in children without asthma have demonstrated a reduction in systemic inflammation .


However , the impact of weight loss in the obese paediatric population with asthma has not been investigated .


To measure the effects of weight loss on markers of systemic inflammation in obese children with bronchial asthma .


Eighty obese children with bronchial asthma ( @ boys , and @ girls ) with mean age @ @ years were divided into two equal groups .


The training group received diet regimen , exercise training in addition to the medical treatment for two months , where the control group received the medical treatment only .


There was a @ % , @ % , @ % , @ % and @ % reduction in mean values of tumor necrosis factor-alpha ( TNF-alpha ) , interleukin-@ ( IL-@ ) , interleukin-@ ( IL-@ ) , Leptin and body mass index ( BMI ) respectively and @ % increase in mean values of adiponectin in the training group .


While , there was a @ % , @ % , @ % , @ % and @ % increase in mean values of TNF-alpha , IL-@ , IL-@ , Leptin and BMI respectively and @ % decrease in mean values of adiponectin in the control group .


The mean values of TNF-alpha , IL-@ , IL-@ , Leptin and BMI was decreased and adiponectin was increased significantly in the training group , however the results of the control group were not significant .


Also , there were significant differences between both groups at the end of the study .


Weight loss improves markers of systemic inflammation in obese Saudi children with bronchial asthma .


To achieve an excellent bowel preparation , it is routine to require a clear liquid diet on the day before the procedure .


Unfortunately , this dietary modification may be poorly tolerated .


We examine whether a change in precolonoscopy dietary restriction can lead to better patient tolerance without compromising examination quality .


This is a prospective , blinded , randomized controlled trial of patients undergoing screening or surveillance colonoscopy .


The primary objective measures the effect of dietary modification on bowel prep quality .


Secondary endpoints include polyp detection , patient tolerance , withdrawal time , and patient acceptance .


A total of @ patients were randomized to either ( a ) a low-residue diet for breakfast and lunch the day before the procedure or ( b ) clear liquids all day before the procedure .


All patients underwent an identical low-volume sodium sulfate split prep .


Bowel prep quality was scored using the Boston Bowel Preparation Scale ( BBPS ) .


A t test with TOST was used for noninferiority .


Secondary endpoints were compared using analysis .


Overall , @ % of patients had a good or excellent bowel prep ( BBPS = @ , @ , @ , or @ ) .


LRD prep quality was noninferior to CLD prep quality ( LRD @ vs. CLD @ ) .


Polyp detection rates were similar ( @ % vs. @ % , P = @ ) .


Patient tolerance and acceptance did not differ .


Withdrawal times were equivalent between both groups ( @ vs. @ min , P = NS ) .


Patients allowed to have a limited low-residue diet before colonoscopy achieve a bowel prep quality that is noninferior to patients on a strict clear liquid diet limitation .


Furthermore , polyp detection rates , patient tolerance , and patient acceptance were similar between the @ groups .


Prenatal supplementation with micronutrients may increase birth weight and thus improve infant health and survival in settings where infants and children are at risk of micronutrient deficiencies .


To assess whether vitamin A and/or zinc supplementation given during pregnancy can improve birth weight , birth length , neonatal morbidity , or infant mortality .


A double-blind , randomized controlled trial supplementing women ( n = @ ) in Central Java , Indonesia throughout pregnancy with vitamin A , zinc , combined vitamin A + zinc , or placebo .


Out of @ supplemented pregnant women , @ neonates could be evaluated .


Overall , zinc supplementation improved birth length compared to placebo or combined vitamin A + zinc ( @ vs. @ cm , p = @ ) ; vitamin A supplementation improved birth length compared to placebo or combined vitamin A + zinc ( @ vs. @ cm , p = @ ) .


These effects remained after adjusting for maternal height , pre-pregnancy weight , and parity .


There was no effect of supplementation on birth weight , the proportion of low birth weight , neonatal morbidity , or mortality .


Prenatal zinc or vitamin A supplementation demonstrates a small but significant effect on birth length , but supplementation with zinc , vitamin A or a combination of zinc and vitamin A , have no effect on birth weight , neonatal morbidity , or mortality .


Chikungunya is an emerging arthropod-borne disease that has spread from tropical endemic areas to more temperate climates of the USA and Europe .


However , no specific treatment or preventive measure is yet available .


We aimed to investigate the immunogenicity and safety of a live recombinant measles-virus-based chikungunya vaccine .


We did a randomised , double-blind , placebo-controlled , active-comparator , phase @ , dose-escalation study at one centre in Vienna , Austria .


Healthy men and women aged @-@ years with no comorbidities were randomly assigned , by computer-generated block randomisation ( block size of @ ) , to receive either one of three escalating doses of the measles-virus-based candidate vaccine ( low dose -LSB- @ ( @ ) median tissue culture infection doses ( TCID@ ) per @ mL -RSB- , medium dose -LSB- @ ( @ ) TCID@ per @ mL -RSB- , or high dose -LSB- @ ( @ ) TCID@ per @ mL -RSB- ) , or the active comparator-Priorix .


Participants were additionally block-randomised to receive a booster injection on either day @ or day @ after the first vaccination .


Participants and study investigators were masked to group allocation .


The primary endpoint was the presence of neutralising anti-chikungunya antibodies on day @ , as assessed by @ % plaque reduction neutralisation test .


Analysis was by intention to treat and per protocol .


This trial is registered with EudraCT , number @-@-@ .


Between Nov @ , @ , and Feb @ , @ , we randomly assigned @ participants to receive the low dose ( n = @ ) , the medium dose ( n = @ ) , or the high dose ( n = @ ) of the measles-virus-based candidate vaccine , or Priorix ( n = @ ) , of whom @ participants ( @ % ; n = @ , n = @ , n = @ , n = @ , respectively ) were included in the per-protocol population .


The candidate vaccine raised neutralising antibodies in all dose cohorts after one immunisation , with seroconversion rates of @ % ( n = @ ) in the low-dose group , @ % ( n = @ ) in the medium-dose group , and @ % ( n = @ ) in the high-dose group .


The immunogenicity of the candidate vaccine was not affected by pre-existing anti-measles immunity .


The second vaccination resulted in a @ % seroconversion for all participants in the candidate vaccine groups .


The candidate vaccine had an overall good safety profile , and the rate of adverse events increased with vaccine dose and volume .


No vaccination-related serious adverse events were recorded .


The live recombinant measles-virus-based chikungunya vaccine had good immunogenicity , even in the presence of anti-vector immunity , was safe , and had a generally acceptable tolerability profile .


This vaccine is the first promising measles-virus-based candidate vaccine for use in human beings .


Diabetes mellitus is an independent risk factor for cardiovascular disease .


To compare the efficacy of devices for continuous glucose monitoring and capillary glucose monitoring in hospitalized patients with acute coronary syndrome using the following parameters : time to achieve normoglycemia , period of time in normoglycemia , and episodes of hypoglycemia .


We performed a pilot , non-randomized , unblinded clinical trial that included @ patients with acute coronary artery syndrome , a capillary or venous blood glucose @ mg/dl , and treatment with a continuous infusion of fast acting human insulin .


These patients were randomized into @ groups : a conventional group , in which capillary measurement and recording as well as insulin adjustment were made every @h , and an intervention group , in which measurement and recording as well as insulin adjustment were made every hour with a subcutaneous continuous monitoring system .


Student 's t-test was applied for mean differences and the X ( @ ) test for qualitative variables .


We observed a statistically significant difference in the mean time for achieving normoglycemia , favoring the conventional group with a P = @ .


Continuous monitoring systems are as useful as capillary monitoring for achieving normoglycemia .


The use of a video-assisted laryngoscope ( VL ) has been shown to reduce the time to achieve intubation with a double-lumen endobronchial tube ( DLT ) .


As the blade of the VL is curved differently to a standard laryngoscope , the DLT must be angled into a hockey stick shape to fit properly .


We conducted a study to establish which direction of angulation was best to facilitate correct positioning of the DLT when using a VL .


We enrolled patients scheduled for thoracic surgery who required intubation with a DLT .


They were prospectively randomized into one of two groups : those intubated with a DLT angled to conceal the tracheal orifice ( the tracheal orifice-covered , TOC ) group or the tracheal orifice-exposed ( TOE ) group .


The composite primary outcome measures were time taken to intubate and the frequency of first-time success .


The time taken to intubate was divided into : T@ , the time from mouth opening to visualization of the vocal cords with the VL ; and T@ , the time taken to advance the DLT through the cords until its tip lay within the trachea and three carbon dioxide waveforms had been detected by capnography .


The hemodynamic responses to intubation and intubation-related adverse events were also recorded .


Sixty-six patients completed the study , with @ in each group .


Total intubation time was significantly shorter in the TOC group ( mean @ standard deviation @ seconds versus @ seconds , p < @ ) .


T@ was also significantly shorter in the TOC group than the TOE group ( @ seconds versus @ seconds , p < @ ) .


The severity of hoarseness on the first postoperative day and sore throat on the fourth postoperative day were significantly lower in the TOC group than the TOE group ( p = @ and < @ , respectively ) .


The hemodynamic responses to intubation were broadly similar between the groups .


When placing a left-sided DLT using a VL , angling the bronchial lumen to a hockey stick shape that conceals the tracheal lumen saves time and ameliorates the severity of post-intubation complications .


The aim of this study was to investigate the comparison of massage therapy and routine physical therapy on patients with sub acute and chronic nonspecific low back pain .


Thirty volunteer female subjects with a sub acute or chronic nonspecific low back pain were randomly enrolled in two groups , massage therapy and routine physical therapy .


After massage application , the hamstring and paravertebral muscles stretching and also stabilizing exercises were prescribed .


In the routine physical therapy group , TENS , US and vibrator were used besides exercises .


Pain intensity according to Numerical Rating Scale , functional disability level in accordance to Oswestry Disability Index , and modified Schober test , for measurement of flexion range of motion , before and after ten sessions of treatment were used to evaluate the effectiveness of the treatment .


Pain intensity , Oswestry Disability Index and flexion range of motion had shown significant differences before and after intervention in both groups ( p < @ ) .


The statistical analysis revealed that the massage therapy had significantly improved the pain intensity and Oswestry Disability Index compared to routine physical therapy ( p = @ , p = @ respectively ) , but the range of motion changes were not significant between two groups ( p = @ ) .


It can be concluded that both massage therapy and routine physical therapy are useful for sub acute and chronic nonspecific low back pain treatment especially if accompanied with exercise .


However , massage is more effective than other electrotherapy modalities , and it can be used alone or with electrotherapy for the treatment of patients with low back pain .


The aim of this study was to compare the efficacy and safety of once-weekly albiglutide with once-daily insulin glargine ( A@Gly , B@Arg , B@Arg human insulin ) in patients with type @ diabetes inadequately controlled on metformin with or without sulfonylurea .


This was a randomised , open-label , multicentre ( n = @ ) , parallel-group , non-inferiority out-patient clinical trial , with @ patients enrolled in the study .


The study was conducted in @ centres located in four countries .


Patients aged @ years with type @ diabetes treated with metformin ( sulfonylurea ) for at least @ months with a baseline HbA@c @-@ @ % ( @-@ @ mmol/mol ) were randomly assigned ( @:@ ) via a computer-generated randomisation sequence with a voice response system to receive albiglutide ( @ mg once a week , n = @ ) or insulin glargine ( @ U once a day , n = @ ) added to current therapy .


Participants and investigators were not masked to treatment assignment .


Doses of each medication were adjusted on the basis of the glycaemic response .


The primary endpoint was change from baseline in HbA@c at week @ .


In the albiglutide group , HbA@c declined from @ % ( @ mmol/mol ) ( meanSD ) at baseline to @ % ( @ mmol/mol ) at week @ .


A similar reduction occurred in the insulin glargine group ( @ % to @ % -LSB- @ to @ mmol/mol -RSB- ) .


The model-adjusted treatment difference of @ % ( @ % CI -@ % , @ % ) ( @ mmol/mol -LSB- @ % CI -@ , @ mmol/mol -RSB- ) indicated non-inferiority of albiglutide to insulin glargine based on the pre-specified non-inferiority margin of @ % ( @ mmol/mol , p = @ ) .


Body weight increased in the insulin glargine group and decreased in the albiglutide group , with a mean treatment difference of -@ kg ( @ % CI -@ , -@ ; p < @ ) .


Documented symptomatic hypoglycaemia occurred in a higher proportion of patients in the insulin glargine group than in the albiglutide group ( @ % vs @ % , p = @ ) .


Albiglutide was non-inferior to insulin glargine at reducing HbA@c at week @ , with modest weight loss and less hypoglycaemia .


Both drugs were well tolerated .


Albiglutide may be considered an alternative to insulin glargine in this patient population .


Cervical dilatation documented on partogram indicates expected rate of progress of labour and deviations from alert line indicates abnormal progress of labour .


Its early detection and timely intervention can reduce fetomaternal morbidity .


To study the role of partogram in the management of labouring mothers with high risk pregnancies at a tertiary care centre .


Four hundred primigravidas with high risk pregnancies in active labour ( with cervical dilatation @ cm ) were studied , divided into two groups as Partogram and no Partogram group and each group consisted of @ patients .


In Partogram group , progress of labour was documented on modified WHO partograph along with the notes on progress sheet of case record file while by standard notes only in no Partogram group .


Cases included were pregnancy-induced hypertension , gestational diabetes mellitus , cholestasis , hypothyroidism , history of previous one LSCS for trial of labour , postdated pregnancy .


Management of labour was standardised using set protocols of intrapartum care followed by analysis of duration of labour , rate of intervention , maternal and perinatal outcomes in both group .


Though percentage of normal vaginal delivery was higher in Partogram group ( @ % ) than no Partogram group ( @ % ) , no statistically significant difference was found between two groups regarding mean duration of active phase of first and second stage of labour , rate of operative vaginal deliveries ( partogram @ % and no partogram @ % ) and of caesarean section ( Partogram @ % , no Partogram @ % ) and perinatal outcome .


In this study , partogram had no significant impact on duration of labour , rate of operative interventions and perinatal outcome following its use in the labour management of high risk pregnancies .


To evaluate how soft lens power affects rigid gas-permeable ( RGP ) lens power and visual acuity ( VA ) in piggyback fittings for keratoconus .


Sixteen keratoconus subjects ( @ eyes ) were included in the study .


Piggyback contact lens fittings combining Senofilcon-A soft lenses of -@ , -@ , +@ and +@ D with Rose K@ RGP contact lenses were performed .


Corneal topography was taken on the naked eye and over each soft contact lens before fitting RGP lenses .


Mean central keratometry , over-refraction , RGP back optic zone radius ( BOZR ) and estimated final power as well as VA were recorded and analyzed .


In comparison to the naked eye , the mean central keratometry flattened with both negative lens powers ( p < @ in all cases ) , did not change with the +@ soft lens power ( p = @ ) ; and steepened with the +@ soft lens power ( p = @ ) .


Rigid gas-permeable over-refraction did not change significantly between different soft lens powers ( all p > @ ) .


RGP 's BOZR decreased significantly with both positive in comparison with both negative soft lens powers ( all p < @ ) , but no significant differences were found among negative - or positive-powers separately ( both p > @ ) .


Estimated RGP 's final power increased significantly with positive in comparison with negative lens powers ( all p < @ ) , but no significant differences were found among negative or positive lens powers separately ( both p > @ ) .


Visual acuity did not change significantly between the different soft lens powers assessed ( all p > @ ) .


The use of negative-powered soft lenses in piggyback fitting reduces RGP lens power without impacting VA in keratoconus subjects .


Leading medical organizations have called on primary care pediatricians to take a central role in the prevention of childhood obesity .


Weight counseling typically has not been incorporated into routine pediatric practice due to time and training constraints .


Brief interventions with simple behavior change messages are needed to reach high-risk children , particularly Latino and Black children who are disproportionately affected by obesity and related comorbidities .


Steps to Growing Up Healthy ( Added Value ) is a randomized controlled trial testing the efficacy of brief motivational counseling ( BMC ) delivered by primary care clinicians and the added value of supplementing BMC with monthly contact by community health workers ( CHW ) in the prevention/reversal of obesity in Latino and Black children ages @-@years old .


Mother-child dyads ( targeted n = @ ) are recruited for this @-month randomized trial at an inner-city pediatric primary care clinic and randomized to : @ ) BMC delivered by clinicians and nurses at well , sick , and WIC visits with the goal of reducing obesogenic behaviors ( BMC ) ; @ ) BMC plus monthly phone calls by a CHW ( BMC+P hone ) ; or @ ) BMC plus monthly home visits by a CHW ( BMC+H ome ) .


During BMC , the medical team facilitates the selection of a specific goal ( i.e. , reduce sugar sweetened beverage consumption ) that is meaningful to the mother and teaches the mother simple behavioral strategies .


Monthly contacts with CHWs are designed to identify and overcome barriers to goal progress .


Dyads are assessed at baseline and @months and the primary outcome is change in the child 's BMI percentile .


We hypothesize that BMC+P hone and BMC+H ome will produce greater reductions in BMI percentiles than BMC alone and that BMC+H ome will produce greater reductions in BMI percentiles than BMC+P hone .


Steps to Growing Up Healthy will provide important information about whether a brief primary care-based intervention that utilizes a motivational interviewing and goal setting approach can be incorporated into routine care and is sufficient to prevent/reverse obesity in young children .


The study will also explore whether monthly contact with a community health worker bridges the gap between the clinic and the community and is an effective strategy for promoting obesity prevention in high-risk families .


To examine the associations between treatment/outcome expectations , alliance before and during treatment , and the impact of alliance on symptomatic improvement .


One hundred and fifty-three depressed patients randomized to dynamic supportive-expressive psychotherapy ( SET ) , antidepressant medication ( ADM ) or placebo ( PBO ) + clinical management completed ratings of treatment expectations , therapeutic alliance ( CALPAS , WAI-S ) , and depressive symptoms ( HAM-D ) .


Pretreatment expectations of the therapeutic alliance were significantly related to alliance later in therapy but did not differ across treatments and did not predict outcome .


Alliance development over time differed between treatments ; it increased more in SET than in PBO .


After controlling for prior symptom improvement , early alliance predicted subsequent depression change .


Expectations of alliance and of treatment outcome/improvement , measured prior to treatment onset , predicted subsequent alliance .


Successful implementation is a vital precondition for investigating the outcome of care innovation .


This study concerned the evaluation of the implementation of integrated emotion-oriented care ( IEOC ) in psychogeriatric nursing home wards .


The main question was whether the trained caregivers actually applied the knowledge and techniques of IEOC during their daily work .


The study was conducted within the framework of a randomized clinical trial into the effectiveness of IEOC in @ wards .


Preceding the experimental period , staff from @ wards were educated and trained to work with a standardized care plan , resulting in a similar level of quality of care at the start of the trial .


On the experimental wards IEOC was then implemented by training on the job in addition to training courses for personnel .


To examine the implementation effectiveness , a self-report questionnaire , 'Em otion-oriented Skills in the Interaction with Elderly People with Dementia ' , was administered at baseline and after @ months to a sample of caregivers from the experimental and the control wards .


In addition , participant observation was conducted on four experimental and four control wards , and time spent by care personnel on different type of care tasks was registered .


The implementation of IEOC resulted in increased emotion-oriented skills and more knowledge of the residents among the caregivers .


Providing IEOC was not more time consuming for the caregivers than providing usual care .


This study shows that the implementation of IEOC was effective .


It is recommended that in intervention studies the correct application of a new intervention or care approach is examined before jumping to conclusions about the effectiveness of the intervention or care approach itself .


Randomized trials of complex , non-pharmacologic interventions implemented in home and community settings , such as the University of Southern California ( USC ) - Rancho Los Amigos National Rehabilitation Center ( RLANRC ) Pressure Ulcer Prevention Study ( PUPS ) , present unique challenges with respect to ( @ ) participant recruitment and retention , ( @ ) intervention delivery and fidelity , ( @ ) randomization and assessment , and ( @ ) potential inadvertent treatment effects .


We describe the methods employed to address the challenges confronted in implementing PUPS .


In this randomized controlled trial , we are assessing the efficacy of a complex , preventive intervention in reducing the incidence of , and costs associated with , the development of medically serious pressure ulcers in people with spinal cord injury .


Individuals with spinal cord injury recruited from RLANRC were assigned to either a @-month preventive intervention group or a standard care control group .


The primary outcome is the incidence of serious pressure ulcers with secondary endpoints including ulcer-related surgeries , medical treatment costs , and quality of life .


These outcomes are assessed at @ and @ months after randomization .


Additionally , we are studying the mediating mechanisms that account for intervention outcomes .


PUPS has been successfully implemented , including recruitment of the target sample size of @ participants , assurance of the integrity of intervention protocol delivery with an average @ % treatment adherence rate , and enactment of the assessment plan .


However , implementation has been replete with challenges .


To meet recruitment goals , we instituted a five-pronged approach customized for an underserved , ethnically diverse population .


In intervention delivery , we increased staff time to overcome economic and cultural barriers to retention and adherence .


To ensure treatment fidelity and replicability , we monitored intervention protocol delivery in accordance with a rigorous plan .


Finally , we have overcome unanticipated assessment and design concerns related to ( @ ) determining pressure ulcer incidence/severity , ( @ ) randomization imbalance , and ( @ ) inadvertent potential control group contamination .


We have addressed the most daunting challenges encountered in the recruitment , assessment , and intervention phases of PUPS .


Some challenges and solutions may not apply to trials conducted in other settings .


Overcoming challenges has required a multifaceted approach incorporating individualization , flexibility , and persistence , as well as the ability to implement needed mid-course corrections .


The therapeutic effects of antiretroviral treatment ( ART ) in patients with multidrug-resistant tuberculosis ( MDR-TB ) and human immunodeficiency virus ( HIV ) infection have not been established .


To assess therapeutic outcomes of integrating ART with treatment for MDR-TB .


A subgroup of MDR-TB patients from a randomised controlled trial , the SAPiT ( Starting Antiretroviral Therapy at Three Points in Tuberculosis ) study , conducted in an out-patient clinic in Durban , South Africa , from @ to @ .


Clinical outcomes at @ months were compared in patients randomised to receive ART within @ weeks of initiating standard first-line anti-tuberculosis treatment with those who commenced ART after completing anti-tuberculosis treatment .


Mycobacterium tuberculosis drug susceptibility results were available in @ ( @ % ) of @ SAPiT patients : @ had MDR-TB , @ in the integrated treatment arm and @ in the sequential treatment arm .