The care programme consists of an education package and of various structured assessment tools that guide professionals through the multidisciplinary detection , analysis , treatment and evaluation of treatment of challenging behaviour .


Burnout , job satisfaction and job demands were measured before implementation , halfway through the implementation process and after all the care units had implemented the care programme .


Burnout was measured with the Dutch version of the Maslach burnout inventory ( UBOS-C , three subscales ) ; job satisfaction and job demands were measured with subscales of the Leiden Quality of Work Questionnaire .


Mixed model analyses were used to determine effects .


Care staff could not be blinded for the intervention .


Of the 1441 questionnaires , 645 were returned ( response 45 % , 318 control measurements , 327 intervention measurements ) by 380 unique care staff members .


Significant effects were found on job satisfaction ( 0.93 , 95 % CI 0.48-1 .38 ) .


On the other outcomes , no significant changes in the scores were found .


Positive effects of using the Grip on Challenging behaviour care programme were found on job satisfaction , without an increase in job demands .


Novel strategies are required to increase school-based physical activity levels of children .


Integrating physical activity in mathematics lessons may lead to improvements in students ' physical activity levels as well as enjoyment , engagement and learning .


The primary aim of this study is to evaluate the impact of a curriculum-based physical activity integration program known as EASY Minds ( Encouraging Activity to Stimulate Young Minds ) on children 's daily school time physical activity levels .


Secondary aims include exploring the impact of EASY Minds on their engagement and ` on task ' behaviour in mathematics .


Grade 5/6 classes from eight public schools in New South Wales , Australia will be randomly allocated to intervention ( n = 4 ) or control ( n = 4 ) groups .


Teachers from the intervention group will receive one day of professional development , a resource pack and asked to adapt their lessons to embed movement-based learning in their daily mathematics program in at least three lessons per week over a six week period .


Intervention support will be provided via a weekly email and three lesson observations .


The primary outcomes will be children 's physical activity levels ( accelerometry ) across both the school day and during mathematics lessons ( moderate-to-vigorous physical activity and sedentary time ) .


Children 's ` on-task ' behaviour , enjoyment of mathematics and mathematics attainment will be assessed as secondary outcomes .


A detailed process evaluation will be undertaken .


EASY Minds is an innovative intervention that has the potential to improve key physical and academic outcomes for primary school aged children and help guide policy and practice regarding the teaching of mathematics .


Australian and New Zealand Clinical Trials Register ACTRN12613000637741 13/05/2013 .


Daily diaries are a useful way of measuring fluctuations in pain-related symptoms .


However , traditional diaries do not assure the gathering of data in real time , not solving the problem of retrospective assessment .


Ecological momentary assessment ( EMA ) by means of electronic diaries helps to improve repeated assessment .


However , it is important to test its feasibility in specific populations in order to reach a wider number of people who could benefit from these procedures .


The present study compares the compliance and acceptability of an electronic diary running on a smartphone using a crossover design for a sample with a specific pain condition , fibromyalgia and low familiarity with technology .


Forty-seven participants were randomly assigned to one of two conditions : ( 1 ) paper diary - smartphone diary and ( 2 ) smartphone diary - paper diary , using each assessment method for 1 week .


The findings of this study showed that the smartphone diary made it possible to gather more accurate and complete ratings .


Besides , this method was well accepted by a sample of patients with fibromyalgia referred by a public hospital , with an important proportion of participants with low level of education and low familiarity with technology .


The findings of this study support the use of smartphones for EMA even in specific populations with a specific pain condition , fibromyalgia and with low familiarity with technology .


These methods could help clinicians and researchers to gather more accurate ratings of relevant pain-related variables even in populations with low familiarity with technology .


To compare the difference in the efficacy on post-stroke constipation between acupuncture therapy of regulating qi circulation of fe-organ and Shengxue Tongbian Capsules .


Seventy-five patients of post-stroke constipation were randomized into an acupuncture group ( 39 cases ) and a Chinese medicine group ( 36 cases ) .


The unit mode comprehensive therapy of stroke was adopted as basic treatment in the two groups .


In the acupuncture group , acupuncture therapy of regulating qi circulation of fu-organ was added at Tianshu ( ST 25 ) , Zhigou ( TE 6 ) , Qihai ( CV 6 ) and Zusanli ( ST 36 ) , once every day .


In the Chinese medicine group , Shengrue Tongbian Capsules were supplemented for oral administration , once every day , 10 g each time .


The clinical symptom score of constipation was observed before treatment , after 1 and 2 weeks treatment in the two groups , respectively .


The efficacy in 1 week and 2 weeks of treatment and the adverse reaction were observed .


In 1 and 2 weeks of treatment , the clinical symptom score of constipation was reduced significantly as compared with that before treatment in the two groups ( all P < 0.05 ) .


The improvements in the acupuncture group were significant than those in the Chinese medicine group in 2 weeks of treatment ( 8.03 + / - 2.38 vs 9.20 + / - 2.45 , P < 0.05 ) .


Concerning to the occurrence of adverse reaction , there was 1 case of local bruises in needling local site in the acupuncture group ; and there were 1 case of abdominal pain , 3 cases of diarrhea and 2 cases of nausea and vomiting in the Chinese medicine group .


Both the acupuncture therapy of regulating qi circulation of fu-organ and Shengxue Tongbian Capsules achieve the significant efficacy on post-stroke constipation .


The efficacy of the acupuncture therapy of regulating qi circulation of fe-organ is better and the adverse reaction is less after long-term persistent treatment .


Diabetes-associated autoantibodies can be detected in adult-onset diabetes , even when initially non-insulin requiring , i.e. , with latent autoimmune diabetes .


We aimed to identify adult-onset autoimmune diabetes in patients with established `` type 2 diabetes '' participating in the Collaborative Atorvastatin Diabetes Study ( CARDS ) to characterize their phenotype and clinical outcome .


We prospectively studied 2,425 European patients with presumed type 2 diabetes ( mean age 62 years , diabetes duration 7.9 years ) for outcomes at 3.9 years after randomization to either atorvastatin or placebo .


Subjects were screened for autoantibodies to GAD ( GADA ) , insulinoma-associated antigen-2 ( IA-2A ) , and zinc-transporter 8 ( ZnT8A ) .


A total of 173 patients ( 7.1 % ) had GADA , of whom 11 ( 0.5 % ) and 5 ( 0.2 % ) were also positive for IA-2A and ZnT8A , respectively .


At baseline , 44 % of GADA-positive patients were not on insulin .


Fewer autoantibody-positive than autoantibody-negative patients had metabolic syndrome ( 64 vs. 80 % ) , and more were on insulin ( 56 vs. 17 % ) ( P < 0.0001 for each ) without lower HbA1c ( 69 mmol/mol [ 8.5 % ] vs. 62 mmol/mol [ 7.8 % ] ) .


The frequency of microvascular and macrovascular events was similar in both cohorts , independent of atorvastatin .


Adult-onset autoimmune diabetes was prevalent , even in patients with established diabetes presumed to have type 2 diabetes .


After 11.8 years ' diabetes duration , nearly half the patients with autoimmune diabetes were not on insulin treatment and almost two-thirds had metabolic syndrome .


The type of diabetes , whether autoimmune diabetes or type 2 diabetes , did not impact the risk of microvascular disease .


To compare the intraocular pressure ( IOP ) - lowering efficacy and safety of brinzolamide 1 % and brimonidine 0.2 % fixed combination ( BBFC ) with that of brinzolamide 1 % or brimonidine 0.2 % monotherapy , all dosed 2 times per day ( BID ) .


Six-month , phase 3 , randomized , multicenter , double-masked clinical trial .


A total of 560 patients with primary open-angle glaucoma or ocular hypertension who had insufficient IOP reduction with their current therapeutic regimen or who were receiving 2 IOP-lowering medications .


Patients received BBFC ( n = 193 ) , brinzolamide 1 % ( n = 192 ) , or brimonidine 0.2 % ( n = 175 ) BID .


The primary end point was mean change in diurnal IOP from baseline to month 3 .


Supportive end points included mean diurnal IOP change from baseline at week 2 , week 6 , and month 6 ; and mean IOP , mean IOP change from baseline , mean percentage IOP change from baseline , and percentage of patients with IOP < 18 mmHg at week 2 , week 6 , month 3 , and month 6 at each assessment time point ( i.e. , 9 am , 11 am , and 4 pm ) .


Adverse events were recorded throughout the study .


Baseline diurnal IOP was similar among groups ( mean standard deviation : BBFC , 25.9 0.19 mmHg ; brinzolamide , 25.9 0.20 mmHg ; brimonidine , 26.0 0.19 mmHg ) .


At month 3 , BBFC lowered mean diurnal IOP from baseline to a significantly greater extent than brinzolamide ( least squares [ LS ] mean difference : -1.4 mmHg ; P < 0.0001 ; t test ) and brimonidine ( LS mean difference : -1.5 mmHg ; P < 0.0001 ) .


All supportive end points corroborated the results of the primary efficacy analysis .


Mean percentage reductions in IOP from baseline were 26.7 % to 36.0 % with BBFC , 22.4 % to 27.9 % with brinzolamide , and 20.6 % to 31.3 % with brimonidine .


The most common adverse drug reactions were ocular side effects , including hyperemia , blurred vision , allergic-type reactions , and discomfort .


The incidence of hyperemia of the eye was slightly lower with brinzolamide than with BBFC and brimonidine , whereas blurred vision and ocular discomfort were slightly more common with BBFC than with brinzolamide or brimonidine .


Brinzolamide 1 % and brimonidine 0.2 % fixed combination administered BID had a significantly greater IOP-lowering effect than either brinzolamide or brimonidine alone and displayed a safety profile consistent with its individual components .


Femoroacetabular impingement is a common cause of hip/groin symptoms and impaired functional performance in younger sporting populations and results from morphological abnormalities of the hip in which the proximal femur abuts against the acetabular rim .


Many people with symptomatic femoroacetabular impingement undergo arthroscopic hip surgery to correct the bony abnormalities .


While many case series over the past decade have reported favourable surgical outcomes , it is not known whether formal rehabilitation is needed as part of the management of patients undergoing this surgical procedure .


This randomised controlled trial will investigate the efficacy of a progressive physiotherapist-supervised rehabilitation program ( Takla-O'Donnell Protocol ) in improving health-related quality of life , physical function and symptoms in individuals undergoing arthroscopic management of femoroacetabular impingement .


100 people aged 16-35 years undergoing hip arthroscopy for symptomatic femoroacetabular impingement will be recruited from surgical practices in Melbourne , Australia and randomly allocated to either a physiotherapy or control group .


Both groups will receive written information and one standardised post-operative physiotherapy visit whilst in hospital as per usual care .


Those in the physiotherapy group will also receive seven individual 30-minute physiotherapy sessions , including one pre-operative visit ( within 2 weeks of surgery ) and six post-operative visits at fortnightly intervals ( commencing two weeks after surgery ) .


The physiotherapy intervention will incorporate education and advice , manual techniques and prescription of a progressive rehabilitation program including home , aquatic and gym exercises .


The control group will not receive additional physiotherapy management .


Measurements will be taken at baseline ( 2 weeks pre-operatively ) and at 14 and 24 weeks post-surgery .


Primary outcomes are the International Hip Outcome Tool and the sports subscale of the Hip Outcome Score at 14 weeks post-surgery .


Secondary outcomes include the Copenhagen Hip and Groin Outcome Score , the activities of daily living subscale of the Hip Outcome Score , the Heidelberg Sports Activity Score , a modified Tegner Activity Scale and participant-perceived overall change .


The findings from this randomised controlled trial will provide evidence for the efficacy of a specific physiotherapist-supervised rehabilitation program in improving outcomes following arthroscopic management of symptomatic femoroacetabular impingement .


Australian New Zealand Clinical Trials Registry reference number : ACTRN12613000282785 .


Injury prevention effects of neuromuscular training have been partly attributed to postural control adaptations .


Uncertainty exists regarding the magnitude of these adaptations and on how they can be adequately monitored .


The objective was to determine the time course of neuromuscular training effects on functional , dynamic and static balance measures .


Thirty youth ( 14.9 3 years ) field hockey athletes were randomised to an intervention or control group .


The intervention included a 20-min neuromuscular warm-up program performed twice weekly for 10 weeks .


Balance assessments were performed at baseline , week three , week six and post-intervention .


They included the star excursion balance test ( SEBT ) , balance error scoring system ( BESS ) , jump-landing time to stabilization ( TTS ) and center of pressure ( COP ) sway velocity during single-leg standing .


No baseline differences were found between groups in demographic data and balance measures .


Adherence was at 86 % .


All balance measures except the medial-lateral TTS improved significantly over time ( p < 0.05 ) in both groups .


Significant group by time interactions were found for the BESS score ( p < 0.001 ) .


The intervention group showed greater improvements ( 69.3 10.3 % ) after 10 weeks in comparison to controls ( 31.8 22.1 % ) .


There were no significant group by time interactions in the SEBT , TTS and COP sway velocity .


Neuromuscular training was effective in improving postural control in youth team athletes .


However , this effect was not reflected in all balance measures suggesting that the neuromuscular training did not influence all dimensions of postural control .


Further studies are needed to confirm the potential of specific warm-up programs to improve postural control .


To evaluate the effect of monthly intravitreal ranibizumab on hard exudate ( HE ) area and the impact of HE on visual acuity ( VA ) outcomes in diabetic macular edema ( DME ) patients using data from 2 phase III clinical trials .


Exploratory analyses of phase III , randomized , double-masked , sham-controlled , multicenter clinical trials .


Adults with DME , baseline best-corrected VA 20/40 to 20/320 Snellen equivalent , and central foveal thickness of 275 m.


Between the 2 studies , 759 patients with DME were randomized to receive monthly 0.3 or 0.5 mg intravitreal ranibizumab ( Lucentis ; Genentech , Inc. , South San Francisco , CA ) or sham injections .


Hard exudate area was assessed from color fundus stereophotographs both on an ordinal scale and using continuous estimates of areas within the Early Treatment Diabetic Retinopathy Study grid .


Data from 739 eyes were available for analysis .


Mean baseline HE area was similar across treatment groups , ranging from 0.65 to 0.82 mm ( 2 ) .


Through month 24 , the percentage of eyes without HE increased from 20.9 % to 36.3 % in the sham group and from 22.1 % to 61.3 % and 23.6 % to 62.0 % in the ranibizumab 0.3-mg and 0.5-mg groups , respectively .


Resolution of HE became apparent sometime after month 6 in ranibizumab-treated eyes .


At baseline , there was no meaningful correlation between VA and presence or absence of HE .


After baseline , there also was no consistent correlation between presence or absence of HE and change in VA over time .


In this exploratory analysis , monthly intravitreal ranibizumab resulted in significantly greater reduction of HE area compared with sham ( P < 0.0001 ) .


In contrast to the rapid effects of ranibizumab on macular edema , changes in HE area were more gradual .


Contrary to prior expectations , the presence and area of HE did not increase as DME resolved ( either in the ranibizumab or sham groups ) .


Importantly , baseline VA was not correlated with presence of HE , nor was the therapeutic benefit of ranibizumab on VA affected negatively by the presence of HE .


These data suggest that in the context of intravitreal anti-vascular endothelial growth factor therapy , the presence of HE is not a prognostic indicator of poor visual outcomes .


This study aims to assess the extent to which accelerometers can be used to determine the effect of robot-supported task-oriented arm-hand training , relative to task-oriented arm-hand training alone , on the actual amount of arm-hand use of chronic stroke patients in their home situation .


This single-blind randomized controlled trial included 16 chronic stroke patients , randomly allocated using blocked randomization ( n = 2 ) to receive task-oriented robot-supported arm-hand training or task-oriented ( unsupported ) arm-hand training .


Training lasted 8 weeks , 4 times/week , 2 30 min/day using the ( T - ) TOAT ( ( Technology-supported ) - Task-Oriented-Arm-Training ) method .


The actual amount of arm-hand use , was assessed at baseline , after 8 weeks training and 6 months after training cessation .


Duration of use and intensity of use of the affected arm-hand during unimanual and bimanual activities were calculated .


Duration and intensity of use of the affected arm-hand did not change significantly during and after training , with or without robot-support ( i.e. duration of use of unimanual use of the affected arm-hand : median difference of -0.17 % in the robot-group and -0.08 % in the control group between baseline and after training cessation ; intensity of the affected arm-hand : median difference of 3.95 % in the robot-group and 3.32 % in the control group between baseline and after training cessation ) .


No significant between-group differences were found .


Accelerometer data did not show significant changes in actual amount of arm-hand use after task-oriented training , with or without robot-support .


Next to the amount of use , discrimination between activities performed and information about quality of use of the affected arm-hand are essential to determine actual arm-hand performance .


Controlled-trials .


com ISRCTN82787126 .


Cancer survivorship rates have increased in developed countries largely due to population ageing and improvements in cancer care .


Survivorship is a neglected phase of cancer treatment and is often associated with adverse physical and psychological effects .


There is a need for broadly accessible , non-pharmacological measures that may prolong disease-free survival , reduce or alleviate co-morbidities and enhance quality of life .


The aim of the Steps TowaRd Improving Diet and Exercise ( STRIDE ) study is to evaluate the effectiveness of an online-delivered physical activity intervention for increasing walking in cancer survivors living in metropolitan and rural areas of South Australia .


This is a quasi-randomised controlled trial .


The intervention period is 12-weeks with 3-month follow-up .


The trial will be conducted at a university setting and community health services in South Australia .


Participants will be insufficiently active and aged 18 years or older .


Participants will be randomly assigned to either the intervention or control group .


All participants will receive a pedometer but only the intervention group will have access to the STRIDE website where they will report steps , affect and ratings of perceived exertion ( RPE ) during exercise daily .


Researchers will use these variables to individualise weekly step goals to increase walking.The primary outcome measure is steps per day .


The secondary outcomes are a ) health measures ( anthropometric and physiological ) , b ) dietary habits ( consumption of core foods and non-core foods ) and c ) quality of life ( QOL ) including physical , psychological and social wellbeing .


Measures will be collected at baseline , post-intervention and 3-month follow-up .


This protocol describes the implementation of a trial using an online resource to assist cancer survivors to become more physically active .


It is an innovative tool that uses ratings of perceived exertion and daily affect to create individualised step goals for cancer survivors .


The research findings may be of relevance to public health policy makers as an efficacious and inexpensive online-delivered intervention can have widespread application and may improve physical and psychological outcomes among this vulnerable population .


Findings may indicate directions for the implementation of future physical activity interventions with this population .


Australian New Zealand Clinical Trials Registry : ACTRN12613000473763 .


It was the aim of this study to evaluate maintenance therapy with bevacizumab + capecitabine following induction with bevacizumab + capecitabine + oxaliplatin ( XELOX ) versus bevacizumab + XELOX until progression as first-line therapy in metastatic colorectal cancer ( mCRC ) .


Patients received either bevacizumab ( 7.5 mg/kg ) + XELOX ( capecitabine 1,000 mg/m ( 2 ) twice daily on days 1-14 + oxaliplatin 130 mg/m ( 2 ) on day 1 every 3 weeks ) until disease progression ( arm A ) or the same doses of bevacizumab + XELOX for 6 cycles followed by bevacizumab + capecitabine until disease progression ( arm B ) .


The primary endpoint was progression-free survival ( PFS ) ; secondary endpoints included overall survival ( OS ) , objective response rate ( ORR ) and safety .


One hundred and twenty-three patients were randomized .


Treatment compliance was similar in both groups .


Median PFS was significantly longer for arm B than for arm A ( 11.0 vs. 8.3 months ; p = 0.002 ) .


There was no significant difference between the two arms for ORR ( 66.7 vs. 59.0 % ; p = 0.861 ) or median OS ( 23.8 vs. 20.2 months ; p = 0.100 ) .


Tolerability was acceptable in both treatment arms ; the most frequent grade 3/4 treatment-related adverse events ( arm B vs. arm A ) were fatigue ( 6.6 vs. 16.1 % ) , diarrhoea ( 3.3 vs. 11.3 % ) , anorexia ( 3.3 vs. 11.3 % ) , and neuropathy ( 1.6 vs. 8.1 % ) .


Maintenance therapy with bevacizumab + capecitabine can be considered an appropriate option following induction bevacizumab + XELOX in patients with mCRC instead of continuation of bevacizumab + XELOX .


The aim of the present study was to compare the frequency of readmissions due to small bowel obstruction ( SBO ) after open versus laparoscopic surgery performed for suspected acute appendicitis .


Appendicitis is a common disease , with a lifetime risk of approximately 7 % .


Appendectomy is the treatment of choice for most patients .


Postoperative adhesions are common after abdominal surgery , including appendectomy .


Consecutive patients , 16 years or older , operated on because of suspected appendicitis at 2 university hospitals between 1992 and 2007 were included .


The prime approach was open at one hospital and laparoscopic at the other hospital .


Open and laparoscopic procedures were compared retrospectively , reviewing the patients ' charts until the middle of 2012 .


Hospitalization for SBO after index surgery was registered .


A total of 2333 patients in the open group and 2372 patients in the laparoscopic group were included .


The frequency of hospitalization for SBO was low in both groups , although a difference between the groups was identified ( 1.0 % in the open group and 0.4 % in the laparoscopic group ) ( P = 0.015 ) .


Hospitalization due to SBO , between open and laparoscopic procedures , in patients operated on because of suspected appendicitis demonstrated a significant difference , favoring the laparoscopic approach .


The frequency of SBO after the index surgery was , though , low in both groups .


Behavioral approaches and pharmacotherapy are of proven benefit in assisting smokers to quit , but it is unclear whether combining nicotine replacement therapy ( NRT ) with varenicline to improve abstinence is effective and safe .


To evaluate the efficacy and safety of combining varenicline and a nicotine patch vs varenicline alone in smoking cessation .


Randomized , blinded , placebo-controlled clinical trial with a 12-week treatment period and a further 12-week follow-up conducted in 7 centers in South Africa from April 2011 to October 2012 .


Four hundred forty-six generally healthy smokers were randomized ( 1:1 ) ; 435 were included in the efficacy and safety analyses .


Nicotine or placebo patch treatment began 2 weeks before a target quit date ( TQD ) and continued for a further 12 weeks .


Varenicline was begun 1 week prior to TQD , continued for a further 12 weeks , and tapered off during week 13 .


Tobacco abstinence was established and confirmed by exhaled carbon monoxide measurements at TQD and at intervals thereafter up to 24 weeks .


The primary end point was the 4-week exhaled carbon monoxide-confirmed continuous abstinence rate for weeks 9 through 12 of treatment , ie , the proportion of participants able to maintain complete abstinence from smoking for the last 4 weeks of treatment , as assessed using multiple imputation analysis .


Secondary end points included point prevalence abstinence at 6 months , continuous abstinence rate from weeks 9 through 24 , and adverse events .


Multiple imputation also was used to address loss to follow-up .


The combination treatment was associated with a higher continuous abstinence rate at 12 weeks ( 55.4 % vs 40.9 % ; odds ratio [ OR ] , 1.85 ; 95 % CI , 1.19-2 .89 ; P = .007 ) and 24 weeks ( 49.0 % vs 32.6 % ; OR , 1.98 ; 95 % CI , 1.25-3 .14 ; P = .004 ) and point prevalence abstinence rate at 6 months ( 65.1 % vs 46.7 % ; OR , 2.13 ; 95 % CI , 1.32-3 .43 ; P = .002 ) .


In the combination treatment group , there was a numerically greater incidence of nausea , sleep disturbance , skin reactions , constipation , and depression , with only skin reactions reaching statistical significance ( 14.4 % vs 7.8 % ; P = .03 ) ; the varenicline-alone group experienced more abnormal dreams and headaches .


Varenicline in combination with NRT was more effective than varenicline alone at achieving tobacco abstinence at 12 weeks ( end of treatment ) and at 6 months .


Further studies are needed to assess long-term efficacy and safety .


clinicaltrials.gov Identifier : NCT01444131 .


Intensive care unit ( ICU ) - acquired weakness is a frequent complication of critical illness .


It is unclear whether it is a marker or mediator of poor outcomes .


To determine acute outcomes , 1-year mortality , and costs of ICU-acquired weakness among long-stay ( 8 d ) ICU patients and to assess the impact of recovery of weakness at ICU discharge .


Data were prospectively collected during a randomized controlled trial .


Impact of weakness on outcomes and costs was analyzed with a one-to-one propensity-score-matching for baseline characteristics , illness severity , and risk factor exposure before assessment .


Among weak patients , impact of persistent weakness at ICU discharge on risk of death after 1 year was examined with multivariable Cox proportional hazards analysis .


A total of 78.6 % were admitted to the surgical ICU ; 227 of 415 ( 55 % ) long-stay assessable ICU patients were weak ; 122 weak patients were matched to 122 not-weak patients .


As compared with matched not-weak patients , weak patients had a lower likelihood for live weaning from mechanical ventilation ( hazard ratio [ HR ] , 0.709 [ 0.549-0 .888 ] ; P = 0.009 ) , live ICU ( HR , 0.698 [ 0.553-0 .861 ] ; P = 0.008 ) and hospital discharge ( HR , 0.680 [ 0.514-0 .871 ] ; P = 0.007 ) .


In-hospital costs per patient ( +30.5 % , +5,443 Euro per patient ; P = 0.04 ) and 1-year mortality ( 30.6 % vs. 17.2 % ; P = 0.015 ) were also higher .


The 105 of 227 ( 46 % ) weak patients not matchable to not-weak patients had even worse prognosis and higher costs .


The 1-year risk of death was further increased if weakness persisted and was more severe as compared with recovery of weakness at ICU discharge ( P < 0.001 ) .


After careful matching the data suggest that ICU-acquired weakness worsens acute morbidity and increases healthcare-related costs and 1-year mortality .


Persistence and severity of weakness at ICU discharge further increased 1-year mortality .


Clinical trial registered with www.clinicaltrials.gov ( NCT 00512122 ) .


As parents of young children are often unaware their child is overweight , screening provides the opportunity to inform parents and provide the impetus for behaviour change .


We aimed to determine if parents could recall and understand the information they received about their overweight child after weight screening .


Randomised controlled trial of different methods of feedback .


Participants were recruited through primary and secondary care but appointments took place at a University research clinic .


1093 children aged 4-8years were screened .


Only overweight children ( n = 271 , 24.7 % ) are included in this study .


Parents of overweight children were randomised to receive feedback regarding their child 's weight using best practice care ( BPC ) or motivational interviewing ( MI ) at face-to-face interviews typically lasting 20-40min .


244 ( 90 % ) parents participated in a follow-up interview 2weeks later to assess recall and understanding of information from the feedback session .


Interviews were audio-taped and transcribed verbatim before coding for amount and accuracy of recall .


Scores were calculated for total recall and sub-categories of interest .


Overall , 39 % of the information was recalled ( mean score 6.3 from possible score of 16 ) .


Parents given feedback via BPC recalled more than those in the MI group ( difference in total score 0.48 ; 95 % CI 0.05 to 0.92 ) .


Although 94 % of parents were able to correctly recall their child 's weight status , fewer than 10 parents could accurately describe what the measurements meant .


Maternal education ( 0.81 ; 0.25 to 1.37 ) and parental ratings of how useful they found the information ( 0.19 ; 0.04 to 0.35 ) were significant predictors of recall score in multivariate analyses .


While parents remember that their child 's body mass index is higher than recommended , they are unable to remember much of the information and advice provided about the result .


Australian New Zealand Clinical Trials Registry ACTRN12609000749202 .


The limitations of antipsychotic therapy in schizophrenia and schizoaffective disorder led to the investigation of the putative utility of pharmacologic augmentation strategies .


The antitumor agent bexarotene via nuclear retinoid X receptor ( RXR ) activation might modulate numerous metabolic pathways involved in the pathogenesis of schizophrenia and schizoaffective disorder .


This trial aimed to investigate efficacy and safety of add-on bexarotene to ongoing antipsychotic treatment of patients with schizophrenia or schizoaffective disorder .


Ninety inpatients and outpatients that met DSM-IV-TR criteria for schizophrenia or schizoaffective disorder participated in a 6-week , double-blind , randomized , placebo-controlled multicenter study .


Bexarotene ( 75 mg/d ) was added to ongoing antipsychotic treatment from October 2008 to December 2010 .


The reduction in the severity of symptoms on the Positive and Negative Syndrome Scale ( PANSS ) was a primary outcome .


Secondary outcomes included general functioning , quality of life , and side effect scales .


Seventy-nine participants ( 88 % ) completed the protocol .


Controlling for antipsychotic agents , a mixed model showed that patients who received adjunctive bexarotene had significantly lower PANSS positive scale scores compared to patients who received placebo ( F = 8.6 , P = .003 ; treatment arms time , F = 2.7 , P = .049 ) , with moderate effect size ( d = 0.48 ; 95 % CI,0.04-0 .93 ) .


Patients with mean or higher baseline PANSS positive scale scores and patients who did not take lipid-reducing agents revealed greater amelioration of positive symptoms ( F = 7.4 , P = .008 ) .


Other symptoms and secondary outcome measures were not affected by adjunctive bexarotene .


Bexarotene was well tolerated , though 2 reversible side effects were reported : a significant increase in total cholesterol levels ( P < .001 ) and a decrease in total thyroxine levels ( P < .001 ) .


Bexarotene might potentially be a novel adjuvant therapeutic strategy for schizophrenia , particularly for the reduction of positive symptoms .


The potential benefits and risks of ongoing administration of bexarotene warrant further evaluation .


ClinicalTrials.gov identifier : NCT00535574 .


The clinical utility of genotype-guided ( pharmacogenetically based ) dosing of warfarin has been tested only in small clinical trials or observational studies , with equivocal results .


We randomly assigned 1015 patients to receive doses of warfarin during the first 5 days of therapy that were determined according to a dosing algorithm that included both clinical variables and genotype data or to one that included clinical variables only .


All patients and clinicians were unaware of the dose of warfarin during the first 4 weeks of therapy .


The primary outcome was the percentage of time that the international normalized ratio ( INR ) was in the therapeutic range from day 4 or 5 through day 28 of therapy .


At 4 weeks , the mean percentage of time in the therapeutic range was 45.2 % in the genotype-guided group and 45.4 % in the clinically guided group ( adjusted mean difference , [ genotype-guided group minus clinically guided group ] , -0.2 ; 95 % confidence interval , -3.4 to 3.1 ; P = 0.91 ) .


There also was no significant between-group difference among patients with a predicted dose difference between the two algorithms of 1 mg per day or more .


There was , however , a significant interaction between dosing strategy and race ( P = 0.003 ) .


Among black patients , the mean percentage of time in the therapeutic range was less in the genotype-guided group than in the clinically guided group .


The rates of the combined outcome of any INR of 4 or more , major bleeding , or thromboembolism did not differ significantly according to dosing strategy .


Genotype-guided dosing of warfarin did not improve anticoagulation control during the first 4 weeks of therapy .


( Funded by the National Heart , Lung , and Blood Institute and others ; COAG ClinicalTrials.gov number , NCT00839657 . )


Calcium supplements are widely used among older adults for osteoporosis prevention and treatment .


However , their effect on creatinine levels and kidney function has not been well studied .


We investigated the effect of calcium supplementation on blood creatinine concentration in a randomized controlled trial of colorectal adenoma chemoprevention conducted between 2004-2013 at 11 clinical centers in the United States .


Healthy participants ( N = 1,675 ) aged 45-75 with a history of colorectal adenoma were assigned to daily supplementation with calcium ( 1200 mg , as carbonate ) , vitamin D3 ( 1000 IU ) , both , or placebo for three or five years .


Changes in blood creatinine and total calcium concentration were measured after one year of treatment and multiple linear regression was used to estimate effects on creatinine concentrations .


After one year of treatment , blood creatinine was 0.0130.006 mg/dL higher on average among participants randomized to calcium compared to placebo after adjustment for other determinants of creatinine ( P = 0.03 ) .


However , the effect of calcium treatment appeared to be larger among participants who consumed the most alcohol ( 2-6 drinks/day ) or whose estimated glomerular filtration rate ( eGFR ) was less than 60 ml/min/1 .73 m2 at baseline .


The effect of calcium treatment on creatinine was only partially mediated by a concomitant increase in blood total calcium concentration and was independent of randomized vitamin D treatment .


There did not appear to be further increases in creatinine after the first year of calcium treatment .


Among healthy adults participating in a randomized clinical trial , daily supplementation with 1200 mg of elemental calcium caused a small increase in blood creatinine .


If confirmed , this finding may have implications for clinical and public health recommendations for calcium supplementation .


ClinicalTrials.gov NCT00153816 .


Example-based learning using worked examples can foster clinical reasoning .


Worked examples are instructional tools that learners can use to study the steps needed to solve a problem .


Studying worked examples paired with completion examples promotes acquisition of problem-solving skills more than studying worked examples alone .


Completion examples are worked examples in which some of the solution steps remain unsolved for learners to complete .


Providing learners engaged in example-based learning with self-explanation prompts has been shown to foster increased meaningful learning compared to providing no self-explanation prompts .


Concept mapping and concept map study are other instructional activities known to promote meaningful learning .


This study compares the effects of self-explaining , completing a concept map and studying a concept map on conceptual knowledge and problem-solving skills among novice learners engaged in example-based learning .


Ninety-one physiotherapy students were randomized into three conditions .


They performed a pre-test and a post-test to evaluate their gains in conceptual knowledge and problem-solving skills ( transfer performance ) in intervention selection .


They studied three pairs of worked/completion examples in a digital learning environment .


Worked examples consisted of a written reasoning process for selecting an optimal physiotherapy intervention for a patient .


The completion examples were partially worked out , with the last few problem-solving steps left blank for students to complete .


The students then had to engage in additional self-explanation , concept map completion or model concept map study in order to synthesize and deepen their knowledge of the key concepts and problem-solving steps .


Pre-test performance did not differ among conditions .


Post-test conceptual knowledge was higher ( P < .001 ) in the concept map study condition ( 68.821.8 % ) compared to the concept map completion ( 52.817.0 % ) and self-explanation ( 52.221.7 % ) conditions .


Post-test problem-solving performance was higher ( P < .05 ) in the self-explanation ( 63.216.0 % ) condition compared to the concept map study ( 53.316.4 % ) and concept map completion ( 51.013.6 % ) conditions .


Students in the self-explanation condition also invested less mental effort in the post-test .


Studying model concept maps led to greater conceptual knowledge , whereas self-explanation led to higher transfer performance .


Self-explanation and concept map study can be combined with worked example and completion example strategies to foster intervention selection .


To evaluate the effectiveness and safety of nitrous oxide/oxygen inhalation sedation in the treatment of acute pulpitis .


The study population comprised 72 patients of acute pulpitis treated from September 2012 to March 2013 .


They were randomly divided into 2 groups , which included experimental group ( 37 cases ) and control group ( 35 cases ) .


Venham clinical anxiety , cooperative behavior level and WHO clinical pain level evaluation were conducted for the patients .


Wilcoxon and Chi-square test were used respectively for statistical analysis with SPSS 14.0 software package .


In the experimental group , 86.5 % cases behaved comfortable , while in the control group the rate was only 42.9 % .


94.6 % of the patients in the experimental group felt painless after therapy .


The proportion of that in the control group was 68.6 % .


There was significant difference between the 2 groups ( P < 0.01 ) .


The technique of nitrous oxide/oxygen inhalation sedation provides a safe and effective way to release pain and anxiety during treatment of acute pulpitis , while the long-term clinical result still needs further investigation .


To observe the influence of moxibustion temperature on blood lipids , endothelin-1 ( ET-1 ) , nitric oxide ( NO ) , and ET-1 / NO in hyperlipidemia patients .


Forty-two primary hyperlipidemia patients were randomly divided into two groups of 21 and treated with moxibustion at different temperatures .


Moxibustion was performed with the moxa roll 2.5-3 .0 cm from the skin in the treatment group and 4 cm in the control group , 10 min per point , once every other day .


Skin temperature was precisely measured with a thermometer during moxibustion .


After a 12-week treatment , seven measurements of blood lipids , ET-1 , and NO were recorded .


Total cholesterol and triglyceride , were lower in the treatment group than in the control group ( P < 0.05 ) .


Serum ET-1 and ET-1 / NO was obviously lowered in the treatment group ( P < 0.001 ) .


Moxibustion regulated NO and ET-1 / NO in the treatment group much better than in the control group .


Moxibustion can regulate blood lipids and clear blood vessels .


Moxibustion at 45 degrees C has a better effect than moxibustion at 38 degrees C on regulating blood lipids and protecting vascular endothelial function , indicating that suitable temperature influences the curative effect of moxibustion .


In 2007 , we began the randomised phase 3 multicentre HYPRO trial to investigate the effect of hypofractionated radiotherapy compared with conventionally fractionated radiotherapy on relapse-free survival in patients with prostate cancer .


Here , we examine whether patients experience differences in acute gastrointestinal and genitourinary adverse effects .


In this randomised non-inferiority phase 3 trial , done in seven radiotherapy centres in the Netherlands , we enrolled intermediate-risk or high-risk patients aged between 44 and 85 years with histologically confirmed stage T1b-T4 NX-0MX-0 prostate cancer , a PSA concentration of 60 ng/mL or lower , and WHO performance status of 0-2 .


A web-based application was used to randomly assign ( 1:1 ) patients to receive either standard fractionation with 39 fractions of 2 Gy in 8 weeks ( five fractions per week ) or hypofractionation with 19 fractions of 34 Gy in 65 weeks ( three fractions per week ) .


Randomisation was done with minimisation procedure , stratified by treatment centre and risk group .


The primary endpoint is 5-year relapse-free survival .


Here we report data for the acute toxicity outcomes : the cumulative incidence of grade 2 or worse acute and late genitourinary and gastrointestinal toxicity .


Non-inferiority of hypofractionation was tested separately for genitourinary and gastrointestinal acute toxic effects , with a null hypothesis that cumulative incidences of each type of adverse event were not more than 8 % higher in the hypofractionation group than in the standard fractionation group .


We scored acute genitourinary and gastrointestinal toxic effects according to RTOG-EORTC criteria from both case report forms and patients ' self-assessment questionnaires , at baseline , twice during radiotherapy , and 3 months after completion of radiotherapy .


Analyses were done in the intention-to-treat population .


Patient recruitment has been completed .


This study is registered with www.controlled-trials.com , number ISRCTN85138529 .


Between March 19 , 2007 , and Dec 3 , 2010 , 820 patients were randomly assigned to treatment with standard fractionation ( n = 410 ) or hypofractionation ( n = 410 ) .


3 months after radiotherapy , 73 ( 22 % ) patients in the standard fractionation group and 75 ( 23 % ) patients in the hypofractionation group reported grade 2 or worse genitourinary toxicity ; grade 2 or worse gastrointestinal toxicity was noted in 43 ( 13 % ) patients in the standard fractionation group and in 42 ( 13 % ) in the hypofractionation group .


Grade 4 acute genitourinary toxicity was reported for two patients , one ( < 1 % ) in each group .


No grade 4 acute gastrointestinal toxicities were observed .


We noted no significant difference in cumulative incidence by 120 days after radiotherapy of grade 2 or worse acute genitourinary toxicity ( 578 % [ 95 % CI 529-627 ] in the standard fractionation group vs 605 % ( 558-653 ) in the hypofractionation group ; difference 27 % , 90 % CI -299 to 848 ; odds ratio [ OR ] 112 , 95 % CI 084-149 ; p = 043 ) .


The cumulative incidence of grade 2 or worse acute gastrointestinal toxicity by 120 days after radiotherapy was higher in patients given hypofractionation ( 312 % [ 95 % CI 266-358 ] in the standard fractionation group vs 420 % [ 372-469 ] in the hypofractionation group ; difference 108 % , 90 % CI 525-1643 ; OR 16 ; p = 00015 ; non-inferiority not confirmed ) .


Hypofractionated radiotherapy was not non-inferior to standard fractionated radiotherapy in terms of acute genitourinary and gastrointestinal toxicity for men with intermediate-risk and high-risk prostate cancer .


In fact , the cumulative incidence of grade 2 or worse acute gastrointestinal toxicity was significantly higher in patients given hypofractionation than in those given standard fractionated radiotherapy .


Patients remain in follow-up for efficacy endpoints .


The Dutch Cancer Society .


To compare the outcome in patients who underwent surgery for unstable intertrochanteric femoral fractures using the proximal femoral locking plate versus the dynamic hip screw ( DHS ) .


15 men and 5 women aged 32 to 78 ( mean , 55 ) years were randomised to the proximal femoral locking plate group , whereas 14 men and 6 women aged 38 to 75 ( mean , 59 ) years were randomised to the conventional 135-degree DHS group .


The time to union , medialisation of the shaft , neck-shaft angle , limb shortening , varus collapse , and functional outcome ( using the Hospital for Special Surgery Hip Rating System ) were assessed .


Respectively in the locking plate and DHS groups , the mean times to union were 14.6 and 16.5 weeks ( p = 0.067 ) and the mean limb shortenings were 0.3 and 1.4 cm ( p < 0.001 ) .


Medialisation of the shaft occurred in 0 and 15 patients ( p < 0.0001 ) ; varus collapse occurred in 2 and 5 patients ( p = 0.408 ) ; the functional hip score was good-to-excellent in 18 and 11 patients ( p = 0.031 ) ; deep wound infection occurred in 3 and 2 patients ; and implant cut-out occurred in one patient each group .


A non-collapsing locking plate achieved bone union in unstable intertrochanteric fractures with lower risks of limb shortening and medialisation of the shaft .


The 360 fusion of lumbar segments is a common and well-researched therapy to treat various diseases of the spine .


But it changes the biomechanics of the spine and may cause adjacent segment disease ( ASD ) .


Among the many techniques developed to avoid this complication , one appears promising .


It combines a rigid fusion with a flexible pedicle screw system ( hybrid instrumentation , `` topping off '' ) .


However , its clinical significance is still uncertain due to the lack of conclusive data .


The study is a randomized , therapy-controlled , two-centre trial conducted in a clinical setting at two university hospitals .


If they meet the criteria , outpatients presenting with degenerative disc disease , facet joint arthrosis or spondylolisthesis will be included in the study and randomized into two groups : a control group undergoing conventional fusion surgery ( PLIF - posterior lumbar intervertebral fusion ) , and an intervention group undergoing fusion surgery using a new flexible pedicle screw system ( PLIF + `` topping off '' ) , which was brought on the market in 2013 .


Follow-up examination will take place immediately after surgery , after 6 weeks and after 6 , 12 , 24 and 36 months .


An ongoing assessment will be performed every year.Outcome measurements will include quality of life and pain assessments using validated questionnaires ( ODI - Ostwestry Disability Index , SF-36 - Short Form Health Survey 36 , COMI - Core Outcome Measure Index ) .


In addition , clinical and radiologic ASD , sagittal balance parameters and duration of work disability will be assessed .


Inpatient and 6-month mortality , surgery-related data ( e.g. , intraoperative complications , blood loss , length of incision , surgical duration ) , postoperative complications ( e.g. implant failure ) , adverse events , and serious adverse events will be monitored and documented throughout the study .


New hybrid `` topping off '' systems might improve the outcome of lumbar spine fusion .


But to date , there is a serious lack of and a great need of convincing data on safety or efficacy , including benefits and harms to the patients , of these systems .


Health care providers are particularly interested in such data as these implants are much more expensive than conventional implants .


In such a case , randomized clinical trials are the best way to evaluate benefits and risks .


NCT01852526 .


There is insufficient evidence of a relationship between acupuncture needle sensations ( de qi ) and hypoalgesia .


The aim of this study was to investigate the effects of bidirectional needle rotation at LI10 on acupuncture needle sensations and heat pain thresholds .


Twenty-two healthy participants received one acupuncture needle at LI10 with bidirectional rotation of the needle in one experimental session and one acupuncture needle at LI10 with mock rotation in a separate session , in a randomised order .


Measurements of heat pain thresholds were taken before needle insertion , during needle retention and 15min after needle removal .


At each measurement time point , participants rated needle sensations using the Massachusetts Acupuncture Sensation Scale ( MASS ) and a visual analogue scale ( VAS ) of overall intensity of needle sensation .


Bidirectional needle rotation produced significantly higher scores for VAS , MASStotal , MASSpain and MASSsensation compared with mock rotation ( all p < 0.001 ) .


There were significantly higher pain thresholds relative to pre-intervention baseline during ( p = 0.014 ) and after ( p < 0.001 ) bidirectional needle rotation but not during ( p = 0.1 ) or after ( p = 0.62 ) mock bidirectional needle rotation .


Bidirectional needle rotation increased the pain threshold relative to baseline 15min after the needles were removed ( p = 0.009 ) .


A significant but low correlation between needle sensation and change in pain threshold after needling was only found when data from mock and rotation interventions were combined .


Needle rotation increases the magnitude of hypoalgesia .


There is tentative evidence that needle sensation may be associated with the amount of change in pain threshold .


This study investigated the relationship of gratitude to wisdom .


Both constructs are conceptually related to self-reflectivity , but they differ in their emphasis on extrapersonal resources .


Previous wisdom research has focused mainly on intrapersonal capacities .


In Study 1 , 47 wisdom nominees and 47 control participants were interviewed about their most difficult and best life event and filled out a questionnaire on sources of gratitude .


Study 2 was a quantitative study ( N = 443 ) of the relationship between a wisdom scale and scale measures and individual sources of gratitude .


Significantly more wisdom nominees expressed feelings of gratitude spontaneously in their interview .


Wisdom nominees reported gratitude for their life in general , religion , and partner more often than control participants .


In Study 2 , wisdom was related to all gratitude scales and to similar sources of gratitude as in Study 1 .


Both studies found gender differences in gratitude but not wisdom .


Two important implications of these findings are that wisdom entails an appreciation of life and its experiences , especially the growth opportunities that may result from negative events , and that there may be substantial differences between male and female pathways to wisdom .


To investigate the impact of including fluorine-18 fludeoxyglucose ( ( 18 ) F-FDG ) positron emission tomography ( PET ) scanning in the planning of paediatric radiotherapy ( RT ) .


Target volumes were first delineated without and subsequently re-delineated with access to ( 18 ) F-FDG PET scan information , on duplicate CT sets .


RT plans were generated for three-dimensional conformal photon RT ( 3DCRT ) and intensity-modulated proton therapy ( IMPT ) .


The results were evaluated by comparison of target volumes , target dose coverage parameters , normal tissue complication probability ( NTCP ) and estimated risk of secondary cancer ( SC ) .


Considerable deviations between CT - and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied .


However , averaging over the whole cohort , CT or PET/CT guidance introduced no significant difference in the shape or size of the target volumes , target dose coverage , irradiated volumes , estimated NTCP or SC risk , neither for IMPT nor 3DCRT .


Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients .


There were no general trends of increasing or decreasing irradiated volumes , suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected .


( 18 ) F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only .


3 out of 11 patients had a distinct change of target volumes when PET-guided planning was introduced .


Dice and mismatch metrics are not sufficient to assess the consequences of target volume differences in the context of RT. .


High success rate of intubation and short intubation time have been needed to endoscopists for a complete and comfortable colonoscopy , if possible .


The purpose of present study was to compare procedure efficiencies according to adult-colonoscope length .


This was a prospective , randomized , single-blinded controlled trial .


A total of 239 healthy Korean subjects were randomly assigned to two groups : one group receiving intermediate-length adult-colonoscope ( n = 119 ) , and the other group receiving long-length adult-colonoscope ( n = 120 ) .


Cecal intubation time and rate , and terminal ileal intubation time and rate as well as other procedure-related outcomes ( adenoma detection rate , withdrawal time , and total procedure time ) were evaluated .


There were significant differences in cecal intubation time and terminal ileal intubation rate according to colonoscope length .


The time of cecal intubation was shorter in the intermediate-scope group than that in the long-scope group ( ( 222.13 101.67 ) s vs. ( 253.85 109.40 ) s , P = 0.014 ) .


However , the rate of terminal ileal intubation was higher in the long-scope group than that in the intermediate-scope group ( 94.2 % vs. 83.2 % , P = 0.007 ) .


In addition , terminal ileal intubation time was also shorter in the long-scope group than that in the intermediate-scope group ( ( 35.21 38.89 ) s vs. ( 44.09 33.87 ) s , P < 0.001 ) .


There were no significant differences in other procedure-related outcomes between the two groups .


The intermediate-length adult-colonoscope had an advantage over the long-length adult-colonoscope regarding cecal intubation time , whereas the long-scope had an advantage over the intermediate-scope regarding the rate and time of terminal ileal intubation .


These results suggest that it is rational to prepare and use these two types of colonoscope properly , instead of employing only one type of colonoscope .


No medical treatment has been reliably shown to halt or reverse disease progression in hypertrophic cardiomyopathy , but the results of several pilot studies have suggested beneficial effects of angiotensin II receptor blockers on left ventricular hypertrophy and fibrosis , which are predictive of an adverse outcome .


We aimed to assess the effect of the angiotensin II receptor blocker losartan on left ventricular hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy .


In this single-centre , randomised , double-blind , placebo-controlled trial , adult patients ( aged 18 years and older ) with obstructive or non-obstructive hypertrophic cardiomyopathy were randomly assigned via computer-based system to losartan ( 100 mg per day ) or placebo for 12 months .


Patients and investigators were masked to assigned treatment .


The primary endpoint was change in left ventricular mass as assessed by cardiac magnetic resonance imaging ( CMR ) or CT. .


Efficacy analyses were done in the modified intention-to-treat population ( all patients with data available at the 12-month follow-up ) .


The trial is registered with ClinicalTrials.gov , number NCT01447654 .


Between Dec 1 , 2011 , and May 1 , 2013 , 318 patients were screened .


133 patients ( mean age 52 years [ SD 13 ] , 35 % women ) consented and were randomly assigned to placebo ( n = 69 ) or losartan ( n = 64 ) .


124 ( 93 % ) patients completed the study and were included in the modified intention-to-treat analysis for the primary endpoint .


After 12 months we noted no significant difference in the change in left ventricular mass between the placebo group and the losartan group ( mean difference 1 g/m ( 2 ) , 95 % CI -3 to 6 ; p = 060 ) .


A decrease in systolic blood pressure in the losartan group ( from mean 127 mm Hg [ SD 12 ] to 121 mm Hg [ 14 ] ; p = 00001 ) confirmed drug compliance ; blood pressure did not decrease in the placebo group .


Two ( 2 % ) patients , both in the placebo group , died from sudden cardiac death during follow-up .


In the losartan group , one ( 1 % ) patient had angioedema , one ( 1 % ) had deterioration of renal function , and one ( 1 % ) had hyperkalaemia .


Treatment was well tolerated by patients with left ventricular outflow obstruction at baseline .


Our findings challenge the generally held view that angiotensin II receptor blockers reduce cardiac hypertrophy .


Treatment with losartan was safe , suggesting that it can be used for other indications in patients with hypertrophic cardiomyopathy , irrespective of obstructive physiology .


Additional studies are needed to assess the effect of angiotensin II receptor blockers in preclinical hypertrophic cardiomyopathy-eg , in genotype-positive but phenotype-negative individuals .


To evaluate electroacupuncture on the efficacy and the safety of gastric and systemic functional recovery in patients with carbon dioxide pneumoperitoneum undergoing gynaecological laparoscopic surgery .


Sixty patients undergoing gynaecological laparoscopic surgery were randomly divided into a regular anesthesia group ( group A ) and a combination electroacupuncture anesthesia group ( group B ) , 30 cases in each group .


The group A were treated with regular general anesthesia , and on the basis of general anesthesia , the group B were treated with electroacupuncture at bilateral Zusanli ( ST 36 ) and Liangqiu ( ST 34 ) by continuous wave and a frequency of 2 Hz 30 minutes before the surgery until the end of the operation .


Sedation scale by Ramsay , nausea , vomiting and mental state scores of postoperative were evaluated and compared between the two groups .


Compared with the group A , the sedation scale ( 1.19 + / - 0.56 vs 1.96 + / - 0.90 ) , nausea score ( 0.59 + / - 0.80 vs 1.81 + / - 0.88 ) , vomiting score ( 0.48 + / - 0.94 vs 1.89 + / - 0.93 ) and mental state score ( 0.96 + / - 0.73 vs 1.69 + / - 0.75 ) were all decreased significantly in the group B ( all P < 0.01 ) .


Combination electroacupuncture anesthesia can relieve postoperative irritable , nausea and vomiting , improve mental state after the operation and promote the gastric and systemic functional recovery .


It is a good method for the adjustment of carbon dioxide pneumoperitoneum during laparoscopic surgery .


To examine whether an efficacious voucher-based incentives intervention for decreasing smoking during pregnancy and increasing fetal growth could be improved without increasing costs .


The strategy was to redistribute the usual incentives so that higher values were available early in the quit attempt .


118 pregnant smokers in greater Burlington , Vermont ( studied December , 2006-June , 2012 ) were randomly assigned to the revised contingent voucher ( RCV ) or usual contingent voucher ( CV ) schedule of abstinence-contingent vouchers , or to a non-contingent voucher ( NCV ) control condition wherein vouchers were provided independent of smoking status .


Smoking status was biochemically verified ; serial sonographic estimates of fetal growth were obtained at gestational weeks 30-34 .


RCV and CV conditions increased point-prevalence abstinence above NCV levels at early ( RCV : 40 % , CV : 46 % , NCV : 13 % , p = .007 ) and late-pregnancy ( RCV : 45 % ; CV : 36 % ; NCV , 18 % ; p = .04 ) assessments , but abstinence levels did not differ between the RCV and CV conditions .


The RCV intervention did not increase fetal growth above control levels while the CV condition did so ( p < .05 ) .


This trial further supports the efficacy of CV for increasing antepartum abstinence and fetal growth , but other strategies ( e.g. , increasing overall incentive values ) will be necessary to improve outcomes further .


The surgical resection of lung disrupts glucose homeostasis and causes hyperglycemia , as in any other major surgery or critical illness .


We performed a prospective study where we carefully lowered hyperglycemia by insulin administration during the surgery , and for the first time we monitored immediate insulin effects on lung physiology and gene transcription .


The levels of blood gases ( pH , pCO2 , pO2 , HCO3 - , HCO3 - std , base excess , FiO2 , and pO2/FiO2 ) were measured at the beginning of surgery , at the end of surgery , and two hours after .


Samples of healthy lung tissue surrounding the tumour were obtained during the surgery , anonymized and sent for subsequent blinded qPCR analysis ( mRNA levels of surfactant proteins A1 , A2 , B , C and D were measured ) .


This study was done on a cohort of 64 patients who underwent lung resection .


Patients were randomly divided , and half of them received insulin treatment during the surgery .


We demonstrated for the first time that insulin administered intravenously during lung resection does not affect levels of blood gases .


Furthermore , it does not induce immediate changes in the expression of surfactant proteins .


According to our observations , short insulin treatment applied intravenously during resection does not affect the quality of breathing .


Postoperative atrial fibrillation is a common complication after cardiac surgery , with an incidence as high as 20-50 % .


Increased age is associated with a significant increase in postoperative atrial fibrillation risk .


This common complication is associated with higher morbidity and mortality rates .


The aim of this study was to assess the efficacy of nebivolol in preventing atrial fibrillation following coronary artery bypass surgery in patients over 60 years of age .


In this prospective randomized study , 200 patients who were candidates for elective coronary artery bypass surgery were divided into two groups .


The first group was administered with nebivolol and the second group was administered with metoprolol .


Treatment was initiated four days prior to surgery , and patients were monitored for atrial fibrillation until discharge .


Forty-one patients received 50 mg metoprolol succinate daily , which was initiated minimum 4 days before surgery .


Demographic data were similar in both groups .


The incidence of postoperative atrial fibrillation in both groups was similar , with no significant difference being identified [ n = 20 ( 20 % ) ; n = 18 ( 18 % ) , P = 0.718 ; respectively ] .


There were not any mortality at both groups during study .


Inotropic agent requirement at ICU was similar for both groups [ n = 12 ( 12 % ) , n = 18 ( 18 % ) , P = 0.32 ] .


We compared the effectiveness of nebivolol and metoprolol in decreasing the incidence of postoperative atrial fibrillation , and determined that nebivolol was as effective as metoprolol in preventing postoperative atrial fibrillation at patients .


Nebivolol may be the drug of choice due to its effects , especially after elective coronary artery bypass surgery .


As a part of nationwide healthcare reforms , the Chinese government launched web-based appointment systems ( WAS ) to provide a solution to problems around outpatient appointments and services .


These have been in place in all Chinese public tertiary hospitals since 2009 .


Questionnaires were collected from both patients and doctors in one large tertiary public hospital in Shanghai , China.Data were analyzed to measure their satisfaction and views about the WAS .


The 1000 outpatients randomly selected for the survey were least satisfied about the waiting time to see a doctor .


Even though the WAS provided a much more convenient booking method , only 17 % of patients used it .


Of the 197 doctors surveyed , over 90 % thought it was necessary to provide alternative forms of appointment booking systems for outpatients .


However , about 80 % of those doctors who were not associated professors would like to provide an ` on-the-spot ' appointment option , which would lead to longer waits for patients .


Patients were least satisfied about the waiting times .


To effectively reduce appointment-waiting times is therefore an urgent issue .


Despite the benefits of using the WAS , most patients still registered via the usual method of queuing , suggesting that hospitals and health service providers should promote and encourage the use of the WAS .


Furthermore , Chinese health providers need to help doctors to take others ' opinions or feedback into consideration when treating patients to minimize the gap between patients ' and doctors ' opinions .


These findings may provide useful information for both practitioners and regulators , and improve recognition of this efficient and useful booking system , which may have far-reaching and positive implications for China 's ongoing reforms .


To examine the prediction of gestational diabetes in obese women using routine clinical measures and measurement of biomarkers related to insulin resistance in the early second trimester .


A total of 117 obese pregnant women participating in a pilot trial of a complex intervention of dietary advice and physical activity were studied .


Blood samples were obtained at recruitment ( 15-17 weeks ' gestation ) and demographic , clinical history and anthropometric measures recorded .


The biomarkers analysed were plasma lipids ( HDL cholesterol , LDL cholesterol , triglycerides ) , high-sensitivity C-reactive protein , alanine transaminase , aspartate transaminase , ferritin , fructosamine , insulin , adiponectin , tissue plasminogen activator , interleukin-6 , visfatin and leptin .


Univariate and logistic regression analyses were performed to determine independent predictors and area under the receiver-operating curve was calculated for the model .


Of the 106 participants included in the analysis , 29 ( 27.4 % ) developed gestational diabetes .


Participants with gestational diabetes were older ( P = 0.002 ) , more often of parity 2 , had higher systolic ( P = 0.02 ) and diastolic blood pressure ( P = 0.02 ) and were more likely to be black ( P = 0.009 ) .


Amongst the blood biomarkers measured , plasma adiponectin alone remained independently associated with gestational diabetes in adjusted models ( P = 0.002 ) .


The area under the receiver-operating curve for clinical factors alone ( 0.760 ) increased significantly ( area under the curve 0.834 , chi-square statistic ( 1 ) = 4.00 , P = 0.046 ) with the addition of adiponectin .


A combination of routinely measured clinical factors and adiponectin measured in the early second trimester in obese women may provide a useful approach to the prediction of gestational diabetes .


Validation in a large prospective study is required to determine the usefulness of this algorithm in clinical practice .


Cyclooxygenase-2 ( COX-2 ) is expressed in all female reproductive organs .


Therefore , inhibitors of COX-2 may affect reproductive function .


We evaluated the effect of extended administration of meloxicam on ovulation and the menstrual cycle .


Our hypothesis was that meloxicam administered from menstrual cycle day 5 - 22 could interfere with follicular rupture , without disrupting the menstrual cycle , and could be a potential non-hormonal contraceptive method .


The study was conducted in 56 healthy sterilized women .


Before the onset of treatment and after the end of treatment , participants were observed during a control cycle to ensure that they had progesterone ( P ) serum levels ( > 12 nmol/l ) consistent with ovulation .


Participants were treated for 18 days , during three consecutive cycles .


They were randomized to 15 or 30 mg/day .


The menstrual cycle was monitored with serial ultrasound and hormone assays in blood .


Fifty-six volunteers completed the study .


In 55 % of cycles treated with 15 mg/day and in 78 % of cycles treated with 30 mg/day ( p < 0.001 ) we observed dysfunctional ovulation defined as follicular rupture not preceded 24-48 h earlier by an LH peak or preceded by a blunted LH peak ( < 21 IU/l ) or not followed by an elevated serum P level > 12 nmol/l .


Ovulation was observed in 44.6 % and in 21.7 % of women in the lower dose group and the higher dose group , respectively .


There were no differences between the two doses in other parameters measured .


There were no serious adverse events and adverse events were not different between doses or between control and treated cycles .


Although administration of meloxicam on menstrual cycle days 5 - 22 resulted in a dose-dependent inhibition of ovulation , more than 20 % of subjects had normal ovulation with the highest dose .


Previous studies have shown that oral meloxicam can delay follicle rupture .


This study investigated daily oral meloxicam as a non-hormonal contraceptive .


Since ovulation occurs in over 20 % of cycles even with a high dose of 30 mg daily , it is not likely that the approach would be a highly effective contraceptive strategy .


Urodynamic studies are commonly performed as part of the preoperative work-up of patients undergoing surgery for stress urinary incontinence ( SUI ) .


We aimed to assess the extent to which these urodynamic parameters influence patient selection and postoperative outcomes .


Patients presenting with SUI were randomly assigned to two groups : one undergoing office evaluation only and the other with a preoperative urodynamic work-up .


Patients with unfavorable urodynamic parameters ( detrusor overactivity [ DO ] and/or Valsalva leak point pressure [ VLPP ] < 60 cm H2O and/or maximum urethral closure pressure [ MUCP ] < 20 cm H2O ) were excluded from the urodynamic testing group .


All patients in both groups underwent the transobturator midurethral sling procedure .


Evaluation for treatment success ( reductions in urogenital distress inventory and incontinence impact questionnaire scoring along with absent positive stress test ) was done at 6 months and 1 year postoperatively .


A total of 72 patients were evaluated .


After 12 patients with any one or more of the abnormal urodynamic parameters were excluded , 30 patients were finally recruited in each of the `` urodynamic testing '' and `` office evaluation only '' groups .


At both the 6 - and the 12-month follow-ups , treatment outcomes ( reduction in scores and positive provocative stress test ) were significantly better in the urodynamic testing group than in the office evaluation only group ( p-values significant for all outcomes ) .


Our findings showed statistically significantly better treatment outcomes in the urodynamic group ( after excluding those with poor prognostic indicators such as DO , low VLPP , and MUCP ) than in the office evaluation only group .


We recommend exploiting the prognostic value of these urodynamic parameters for patient counseling and treatment decisions .


Total hip replacement ( THR ) is a common elective surgical procedure and can be effective for reducing chronic pain .


However , waiting times can be considerable .


A pain self-management intervention may provide patients with skills to more effectively manage their pain and its impact during their wait for surgery .


This study aimed to evaluate the feasibility of conducting a randomized controlled trial to assess the effectiveness and cost-effectiveness of a group-based pain self-management course for patients undergoing THR .


Patients listed for a THR at one orthopedic center were posted a study invitation pack .


Participants were randomized to attend a pain self-management course plus standard care or standard care only .


The lay-led course was delivered by Arthritis Care and consisted of two half-day sessions prior to surgery and one full-day session after surgery .


Participants provided outcome and resource-use data using a diary and postal questionnaires prior to surgery and one month , three months and six months after surgery .


Brief telephone interviews were conducted with non-participants to explore barriers to participation .


Invitations were sent to 385 eligible patients and 88 patients ( 23 % ) consented to participate .


Interviews with 57 non-participants revealed the most common reasons for non-participation were views about the course and transport difficulties .


Of the 43 patients randomized to the intervention group , 28 attended the pre-operative pain self-management sessions and 11 attended the post-operative sessions .


Participant satisfaction with the course was high , and feedback highlighted that patients enjoyed the group format .


Retention of participants was acceptable ( 83 % of recruited patients completed follow-up ) and questionnaire return rates were high ( 72 % to 93 % ) , with the exception of the pre-operative resource-use diary ( 35 % return rate ) .


Resource-use completion rates allowed for an economic evaluation from the health and social care payer perspective .


This study highlights the importance of feasibility work prior to a randomized controlled trial to assess recruitment methods and rates , barriers to participation , logistics of scheduling group-based interventions , acceptability of the intervention and piloting resource use questionnaires to improve data available for economic evaluations .


This information is of value to researchers and funders in the design and commissioning of future research .


Current Controlled Trials ISRCTN52305381 .


Evaluate curricular changes related to health literacy and determine impact on independent-living senior residents as part of an introductory pharmacy practice experience for third-year student pharmacists .


Students were randomly assigned a resident whom they visited multiple times to conduct assessments and provide various services using three methods : Ask Me 3 Four Habits Model , and Teach-back .


The study was conducted at independent-living apartments within a 24-mile radius from the St. Louis College of Pharmacy , St. Louis , Missouri .


Participants ( n = 147 to 173 , across all three years ) were volunteer , elderly residents , living at a facility that collaborated with the research .


Within one academic year , students collected medical and medication histories , conducted household safety checks , performed screening assessments , assessed adherence , and provided general recommendations to a resident .


Outcomes included resident satisfaction , student satisfaction , and correlations between student use of health literacy tools and resident satisfaction .


Exit surveys indicated resident overall satisfaction with the program , increased understanding of health-related information , increased confidence in asking health care professionals questions about their health , and greater commitment to medication adherence as a result of the experience .


Students were highly satisfied with the program .


Analyses reveal some correlations between a previously determined performance level of student communication and resident satisfaction .


Students ' use of health literacy communication tools during encounters with independent-living senior residents can result in greater patient understanding and empowerment , which may in turn help improve medication adherence .


Recent research has pointed to the cardiovascular benefits of providing social support to others in times of stress ; however , little is known about what factors influence such benefits .


In a between-groups design , we investigated the possible interaction between intimacy ( friend vs. stranger ) and support type ( active vs. passive ) in determining the cardiovascular responses of support providers .


Eighty participants had their blood pressure and heart rate monitored while providing either active or passive social support to a friend or a stranger who completed a stress task .


Although there was no interaction effect , a significant main effect showed that those who provided passive support showed larger decreases relative to those in the active support condition .


There was no effect of intimacy .


Further , these effects withstood adjustment for a number of potential confounds ( e.g. sex and body mass index ) .


It appears that the greatest physiological benefit for social support providers may come from providing passive , rather than active support , regardless of whether the support receiver is a friend or a stranger .


Many authors recommend performing a second-look endoscopy ( SLE ) to reduce the frequency of delayed bleeding after endoscopic submucosal dissection ( ESD ) for gastric neoplasms , but these recommendations have been made despite a lack of reliable evidence supporting the effectiveness of SLE .


From January 2012 to May 2013 , we investigated 441 gastric neoplasms treated by ESD to assess the risk factors for delayed bleeding .


Delayed bleeding occurred in four of these lesions within 1 postoperation day .


Therefore , we enrolled the patients with the remaining 437 lesions to determine the utility of SLE performed on the morning of postoperative day 2 .


All lesions were randomly assigned to SLE ( 220 lesions ) groups or non-SLE ( 217 lesions ) groups .


Delayed bleeding occurred in 18 lesions ( 4.1 % ) .


A large tumor size ( > 20 mm ) was the only independent risk factor for delayed bleeding ( p = 0.007 ) .


The chance of delayed bleeding was not significantly different between the patients receiving a SLE ( eight cases ) and those patients not receiving a SLE ( six cases , p = 0.787 ) .


Furthermore , SLE for lesions with a large tumor size did not significantly decrease delayed bleeding ( p = 0.670 ) .


SLE had little or no influence on the prevention of delayed bleeding , irrespective of the risk factors .


Chronic ankle instability ( CAI ) occurs in some people after a lateral ankle sprain and often results in residual feelings of instability and episodes of the ankle 's giving way .


Compared with healthy people , patients with CAI demonstrated poor postural control and used a more anteriorly and laterally positioned center of pressure ( COP ) during a single-limb static-balance task on a force plate .


Balance training is an effective means of altering traditional COP measures ; however , whether the overall location of the COP distribution under the foot also changes is unknown .


To determine if the spatial locations of COP data points in participants with CAI change after a 4-week balance-training program .


Randomized controlled trial .


Laboratory .


Thirty-one persons with self-reported CAI .


Participants were randomly assigned to a 4-week balance-training program or no balance training .


We collected a total of 500 COP data points while participants balanced using a single limb on a force plate during a 10-second trial .


The location of each COP data point relative to the geometric center of the foot was determined , and the frequency count in 4 sections ( anteromedial , anterolateral , posteromedial , posterolateral ) was analyzed for differences between groups .


Overall , COP position in the balance-training group shifted from being more anterior to less anterior in both eyes-open trials ( before trial = 319.1 165.4 , after trial = 160.5 149.5 ; P = .006 ) and eyes-closed trials ( before trial = 387.9 123.8 , after trial = 189.4 102.9 ; P < .001 ) .


The COP for the group that did not perform balance training remained the same in the eyes-open trials ( before trial = 214.1 193.3 , after trial = 230.0 176.3 ; P = .54 ) and eyes-closed trials ( before trial = 326.9 134.3 , after trial = 338.2 126.1 ; P = .69 ) .


In participants with CAI , the balance-training program shifted the COP location from anterolateral to posterolateral .


The program may have repaired some of the damaged sensorimotor system pathways , resulting in a more optimally functioning and less constrained system .


Research suggests that the addition of dexmedetomidine to local anesthetics can prolong peripheral nerve blocks ; however , clinical safety data are limited , and interscalene blocks have not been studied .


The present study was designed to test the hypothesis that dexmedetomidine added to ropivacaine would safely enhance the duration of analgesia without adverse effects when compared with ropivacaine alone .


We conducted a single-center , prospective , randomized , triple-blind , controlled trial of 62 patients undergoing elective shoulder surgery under general anesthesia with an interscalene block .


Patients underwent ultrasound-guided interscalene blocks using either 12 mL of 0.5 % ropivacaine or 0.5 % ropivacaine plus 150-g dexmedetomidine .


The primary outcomes were self-reported duration of the nerve block and safety assessment ( adverse effects and neurological sequelae ) .


Data were analyzed in a blinded fashion .


The median duration of the nerve block was 18 hours ( 95 % confidence interval , 18-20 ) in the dexmedetomidine group and 14 hours ( 95 % confidence interval , 14-16 ) in the ropivacaine group ( P = 0.0001 ) .


Dexmedetomidine also lowered pain scores for the first 14 hours postoperatively and significantly hastened the time to sensory ( P = 0.04 ) and motor ( P = 0.002 ) block onset .


Dexmedetomidine lowered heart rate but blood pressures were stable .


Plasma levels of ropivacaine were not different between groups , and plasma dexmedetomidine levels were relatively low .


There were no adverse events or neurological sequelae .


Dexmedetomidine added to ropivacaine for interscalene blocks increased the duration of the nerve block and improved postoperative pain .


These additional efficacy and safety data should encourage further study of peripheral perineural dexmedetomidine in humans .


We hypothesized reduction of 30 days ' in-hospital morbidity , mortality , and length of stay postimplementation of the World Health Organization 's Surgical Safety Checklist ( SSC ) .


Reductions of morbidity and mortality have been reported after SSC implementation in pre - / postdesigned studies without controls .


Here , we report a randomized controlled trial of the SSC .


A stepped wedge cluster randomized controlled trial was conducted in 2 hospitals .


We examined effects on in-hospital complications registered by International Classification of Diseases , Tenth Revision codes , length of stay , and mortality .


The SSC intervention was sequentially rolled out in a random order until all 5 clusters-cardiothoracic , neurosurgery , orthopedic , general , and urologic surgery had received the Checklist .


Data were prospectively recorded in control and intervention stages during a 10-month period in 2009-2010 .


A total of 2212 control procedures were compared with 2263 SCC procedures .


The complication rates decreased from 19.9 % to 11.5 % ( P < 0.001 ) , with absolute risk reduction 8.4 ( 95 % confidence interval , 6.3-10 .5 ) from the control to the SSC stages .


Adjusted for possible confounding factors , the SSC effect on complications remained significant with odds ratio 1.95 ( 95 % confidence interval , 1.59-2 .40 ) .


Mean length of stay decreased by 0.8 days with SCC utilization ( 95 % confidence interval , 0.11-1 .43 ) .


In-hospital mortality decreased significantly from 1.9 % to 0.2 % in 1 of the 2 hospitals post-SSC implementation , but the overall reduction ( 1.6 % -1.0 % ) across hospitals was not significant .


Implementation of the WHO SSC was associated with robust reduction in morbidity and length of in-hospital stay and some reduction in mortality .


To analyse the muscle adaptations induced by two protocols of isometric training performed at different muscle lengths .


Twenty-eight subjects were divided into three groups : one ( K90 ) performed isometric training of the knee extensors at long muscle lengths ( 90 of knee flexion ) for 8 weeks , and the second group ( K50 ) at short muscle lengths ( 50 ) .


The subjects of the third group acted as controls .


Isokinetic dynamometry was utilized to analyse the net moment-angle relationship and vastus lateralis muscle thickness at three different locations , and pennation angles and fascicle length at 50 % of thigh length were measured at rest with ultrasonography .


Only subjects from K90 group showed significant increases in isokinetic strength ( 23.5 % , P < 0.001 ) , while K50 group showed no increases in isokinetic strength : ( 10 % , P > 0.05 ) .


There was a shift in the angle of peak torque of the K90 group to longer muscle lengths ( +14.6 % , P = 0.002 ) with greater increases in isokinetic strength , while the K50 angle shifted to shorter muscle lengths ( -7.3 % , P = 0.039 ) .


Both training groups showed significant increases in muscle thickness , ( K90 9-14 % vs. K50 5-9 % ) but only K90 significantly increased their pennation angles ( 11.7 % , P = 0.038 ) .


Fascicle lengths remained unchanged .


Isometric training at specific knee angles led to significant shifts of peak torque in the direction of the training muscle lengths .


The greater strength gains and the architectural changes with training at long muscle lengths probably come from a combination of different factors , such as the different mechanical stresses placed upon the muscle-tendon complex .


The renoprotective effect of N-acetylcystein in patients undergoing coronary artery bypass graft surgery is controversial .


We assessed the renoprotective effect of the highest dose of N-acetylcystein sanctioned for clinical use in a prospective , double-blind , placebo-controlled study including 70 chronic kidney disease patients , stage 3 or 4 , who underwent coronary artery bypass graft surgery , on cardiopulmonary bypass ( CPB ) and off CPB , and were randomly allocated to receive either N-acetylcystein 150 mg/kg followed by 50 mg/kg for 6 hours in 0.9 % saline or only 0.9 % saline .


Acute kidney injury was defined by the Acute Kidney Injury Network classification .


The incidence of kidney injury was reduced in the N-acetylcystein group ( 57.1 % versus 28.6 % , p = 0.016 ) .


Nonuse of N-acetylcystein ( relative risk 3.58 , 95 % confidence interval : 1.04 to 12.33 , p = 0.04 ) and cardiopulmonary bypass ( relative risk 4.55 , 95 % confidence interval : 1.28 to 16.15 , p = 0.02 ) were independent predictors of kidney injury .


In patients treated with CPB , N-acetylcystein reduced the incidence of kidney injury from 63 % to 46 % .


Oxidative stress was increased in control subjects ( p = 0.01 ) and abolished in patients receiving N-acetylcystein .


Maximum intravenous doses of N-acetylcystein reduce the incidence of acute kidney injury in patients with kidney disease undergoing coronary artery bypass graft surgery , abolish oxidative stress , and mitigate the negative effect of CPB on renal function .


This randomised , double blind prospective study compares intrathecal lidocaine with chloroprocaine in day-case surgery and the influence of a 500 ml pre-load intravenously .


We tested the hypothesis that chloroprocaine provides faster recovery and discharge in day-case surgery .


Secondary we studied the influence of a preload compared with fluid restriction on discharge time and micturition problems .


One hundred patients undergoing day-case arthroscopy were randomised to receive either lidocaine ( L ) 60 mg or chloroprocaine ( CP ) 40 mg intrathecally and this with ( L + , CP + ) or without ( L , CP ) a 500 ml pre-load of crystalloid .


Block characteristics , micturition and discharge times were registered .


Bladder volumes were monitored by ultrasound .


Micturition problems received a micturition score .


Onset and quality of the block were comparable between groups .


Time to regain Bromage 1 and L2 regression were shorter for the CP group compared with the L group .


Voiding ( 168 44 min ) and discharge ( 178 52 min ) were approximately 40 min faster for the CP group compared with the L group .


Pre-load provided faster bladder filling but there were no differences in voiding time within the CP or L group .


The CP + group ( 166 36 min ) was discharged faster than both L groups ( 226 57 min , 227 59 min ) .


More serious micturition problems occurred in the L + group compared with both CP groups .


Chloroprocaine is suitable for day-case surgery because of faster block regression and discharge than lidocaine .


A 500 ml pre-load may not affect discharge but did not increase micturition problems for chloroprocaine .


To compare the efficacy of metformin with insulin in the management of pregnancy with diabetes .


Randomized clinical trial .


Department of Obstetrics and Gynaecology , Maternal and Child Health Centre ( MCH ) , Pakistan Institute of Medical Sciences , Islamabad , from May 2010 to January 2011 .


A total of 68 pregnant patients with diabetes were included in this study .


Patients were randomly divided in to two groups of each 34 patients based on table of random numbers .


One was labelled as group-A and other was labelled as group-B .


Group-A received insulin and group-B received metformin for the management of diabetes .


The mean age was 29.82 4.58 and 29.35 4.97 years in groups-A and B respectively .


Fasting blood sugar level after 1 month was controlled in 22 ( 64.7 % ) patients in group-A and in 27 ( 79.4 % ) in group-B ( p > 0.05 ) .


Fasting blood sugar level at term , remained controlled in 30 ( 88.2 % ) patients in group-A and 27 ( 79.4 % ) in group-B ( p > 0.05 ) .


Comparison of random blood sugar levels within normal limits after 1 month in 25 ( 73.5 % ) in group-A and in 24 ( 70.6 % ) in group-B .


At term , random blood sugar level was controlled in 28 ( 82.4 % ) and 27 ( 79.4 % ) patients in group-A and B , respectively .


Comparison of post-treatment HBA1C level depicts that diabetes controlled in 27 ( 79.4 % ) patients in group-A while in 28 ( 82.3 % ) patients of group-B .


The efficacy of metformin and insulin in controlling diabetes was equal in two groups .


There was no marked difference in efficacy of metformin and insulin in controlling diabetes in pregnant patients in two groups .


Depression is estimated to become the leading cause of disease burden globally by 2030 .


Despite existing efficacious treatments ( both medical and psychotherapeutic ) , a large proportion of patients do not respond to therapy .


Recent insights from evolutionary psychology suggest that , in addition to targeting the proximal causes of depression ( for example , targeting dysfunctional beliefs by cognitive behavioral therapy ) , the distal or evolutionary causes ( for example , inclusive fitness ) should also be addressed .


A randomized superiority trial is conducted to develop and test an evolutionary-driven cognitive therapy protocol for depression , and to compare its efficacy against standard cognitive therapy for depression .


Romanian-speaking adults ( 18 years or older ) with elevated Beck Depression Inventory ( BDI ) scores ( > 13 ) , current diagnosis of major depressive disorder or major depressive episode ( MDD or MDE ) , and MDD with comorbid dysthymia , as evaluated by the Structured Clinical Interview for DSM-IV ( SCID ) , are included in the study .


Participants are randomized to one of two conditions : 1 ) evolutionary-driven cognitive therapy ( ED-CT ) or 2 ) cognitive therapy ( CT ) .


Both groups undergo 12 psychotherapy sessions , and data are collected at baseline , mid-treatment , post-treatment , and the 3-month follow-up .


Primary outcomes are depressive symptomatology and a categorical diagnosis of depression post-treatment .


This randomized trial compares the newly proposed ED-CT with a classic CT protocol for depression .


To our knowledge , this is the first attempt to integrate insights from evolutionary theories of depression into the treatment of this condition in a controlled manner .


This study can thus add substantially to the body of knowledge on validated treatments for depression .


Current Controlled Trials ISRCTN64664414The trial was registered in June 2013 .


The first participant was enrolled on October 3 , 2012 .


This study aimed to examine healthcare provider ( HCP ) recommendations and patient preferences for the insulin pen versus vial-and-syringe in patients with type 2 diabetes mellitus ( T2DM ) and to assess clinical end points and safety outcomes .


Using a randomized , open-label , crossover design , in total , 405 insulin-naive adults with T2DM from 60 centers received basal insulin glargine in one of two device treatment sequences ( 2 weeks of pen followed by 2 weeks of vial-and-syringe , or vice versa ) .


The primary end point , patient device preference , was evaluated at Week 4 ( end of the crossover period ) using the Insulin Injection Preference Questionnaire .


Patient preference and HCP recommendation were assessed with one global item and three subscale items ( blood glucose control , reluctance to use insulin , and long-term insulin use ) using a 5-point scale ranging from 1 = not preferred or not recommended to 5 = preferred or recommended .


Patients were then re-randomized to either pen or vial-and-syringe for further observation ( 6 , 10 , and 30 weeks ) to evaluate clinical end points ( glycosylated hemoglobin [ A1C ] and fasting blood glucose levels ) and safety outcomes ( hypoglycemia and adverse events ) .


Patients reported a significant preference for pens over vial-and-syringe , and HCPs strongly recommended pens over vial-and-syringe ( both P < 0.001 ) .


Consistent response patterns were observed by HCPs and patients for the three subscale items .


Fasting blood glucose , A1C levels , and the incidence of hypoglycemia were comparable in the two groups .


Patients preferred pens over vial-and-syringe , with the pen device also recommended by HCPs , when initiating basal insulin treatment in insulin-naive patients with T2DM .


Rejection is one of the major causes of late cardiac allograft failure and at present can only be diagnosed by invasive endomyocardial biopsies .


We sought to determine whether microRNA profiling could serve as a non-invasive biomarker of cardiac allograft rejection .


We included 113 heart transplant recipients from four referral French institutions ( test cohort , n = 60 , validation cohort , n = 53 ) .


In the test cohort , we compared patients with acute biopsy-proven allograft rejection ( n = 30 ) to matched control patients without rejection ( n = 30 ) , by assessing microRNAs expression in the heart allograft tissue and patients concomitant serum using RNA extraction and qPCR analysis .


Fourteen miRNAs were selected on the basis of their implication in allograft rejection , endothelial activation , and inflammation and tissue specificity .


We identified seven miRNAs that were differentially expressed between normal and rejecting heart allografts : miR-10a , miR-21 , miR-31 , miR-92a , miR-142-3p miR-155 , and miR-451 ( P < 0.0001 for all comparisons ) .


Four out of seven miRNAs also showed differential serological expression ( miR-10a , miR-31 , miR-92a , and miR-155 ) with strong correlation with their tissular expression .


The receiver-operating characteristic analysis showed that these four circulating miRNAs strongly discriminated patients with allograft rejection from patients without rejection : miR-10a ( AUC = 0.975 ) , miR-31 ( AUC = 0.932 ) , miR-92a ( AUC = 0.989 ) , and miR-155 ( AUC = 0.998 , P < 0.0001 for all comparisons ) .


We confirmed in the external validation set that these four miRNAs highly discriminated patients with rejection from those without .


The discrimination capability of the four miRNAs remained significant when stratified by rejection diagnosis ( T-cell-mediated rejection or antibody-mediated rejection ) and time post-transplant .


This study demonstrates that a differential expression of miRNA occurs in rejecting allograft patients , not only at the tissue level but also in the serum , suggesting their potential relevance as non-invasive biomarkers in heart transplant rejection .


There has been little robust evaluation of the outcome of speech and language therapy ( SLT ) intervention for post-stroke dysarthria .


Non-speech oro-motor exercises ( NSOMExs ) are a common component of dysarthria intervention .


A feasibility study was designed and executed , with participants randomized into two groups , in one of which NSOMExs were a component of the intervention programme .