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Sample records for randomly selected hospital

  1. Evaluation of Randomly Selected Completed Medical Records Sheets in Teaching Hospitals of Jahrom University of Medical Sciences, 2009

    Directory of Open Access Journals (Sweden)

    Mohammad Parsa Mahjob

    2011-06-01

    Full Text Available Background and objective: Medical record documentation, often use to protect the patients legal rights, also providing information for medical researchers, general studies, education of health care staff and qualitative surveys is used. There is a need to control the amount of data entered in the medical record sheets of patients, considering the completion of these sheets is often carried out after completion of service delivery to the patients. Therefore, in this study the prevalence of completeness of medical history, operation reports, and physician order sheets by different documentaries in Jahrom teaching hospitals during year 2009 was analyzed. Methods and Materials: In this descriptive / retrospective study, the 400 medical record sheets of the patients from two teaching hospitals affiliated to Jahrom medical university was randomly selected. The tool of data collection was a checklist based on the content of medical history sheet, operation report and physician order sheets. The data were analyzed by SPSS (Version10 software and Microsoft Office Excel 2003. Results: Average of personal (Demography data entered in medical history, physician order and operation report sheets which is done by department's secretaries were 32.9, 35.8 and 40.18 percent. Average of clinical data entered by physician in medical history sheet is 38 percent. Surgical data entered by the surgeon in operation report sheet was 94.77 percent. Average of data entered by operation room's nurse in operation report sheet was 36.78 percent; Average of physician order data in physician order sheet entered by physician was 99.3 percent. Conclusion: According to this study, the rate of completed record papers reviewed by documentary in Jahrom teaching hospitals were not desirable and in some cases were very weak and incomplete. This deficiency was due to different reason such as medical record documentaries negligence, lack of adequate education for documentaries, High work

  2. An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh

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    Hoque Dewan ME

    2012-12-01

    Full Text Available Abstract Background Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. However, the quality of hospital care for children in developing countries has often been found poor. As the first step of a country road map for improving hospital care for children, we assessed the baseline situation with respect to the quality of care provided to children under-five years age in district and sub-district level hospitals in Bangladesh. Methods Using adapted World Health Organization (WHO hospital assessment tools and standards, an assessment of 18 randomly selected district (n=6 and sub-district (n=12 hospitals was undertaken. Teams of trained assessors used direct case observation, record review, interviews, and Management Information System (MIS data to assess the quality of clinical case management and monitoring; infrastructure, processes and hospital administration; essential hospital and laboratory supports, drugs and equipment. Results Findings demonstrate that the overall quality of care provided in these hospitals was poor. No hospital had a functioning triage system to prioritise those children most in need of immediate care. Laboratory supports and essential equipment were deficient. Only one hospital had all of the essential drugs for paediatric care. Less than a third of hospitals had a back-up power supply, and just under half had functioning arrangements for safe-drinking water. Clinical case management was found to be sub-optimal for prevalent illnesses, as was the quality of neonatal care. Conclusion Action is needed to improve the quality of paediatric care in hospital settings in Bangladesh, with a particular need to invest in improving newborn care.

  3. Blocked Randomization with Randomly Selected Block Sizes

    Directory of Open Access Journals (Sweden)

    Jimmy Efird

    2010-12-01

    Full Text Available When planning a randomized clinical trial, careful consideration must be given to how participants are selected for various arms of a study. Selection and accidental bias may occur when participants are not assigned to study groups with equal probability. A simple random allocation scheme is a process by which each participant has equal likelihood of being assigned to treatment versus referent groups. However, by chance an unequal number of individuals may be assigned to each arm of the study and thus decrease the power to detect statistically significant differences between groups. Block randomization is a commonly used technique in clinical trial design to reduce bias and achieve balance in the allocation of participants to treatment arms, especially when the sample size is small. This method increases the probability that each arm will contain an equal number of individuals by sequencing participant assignments by block. Yet still, the allocation process may be predictable, for example, when the investigator is not blind and the block size is fixed. This paper provides an overview of blocked randomization and illustrates how to avoid selection bias by using random block sizes.

  4. Blocked randomization with randomly selected block sizes.

    Science.gov (United States)

    Efird, Jimmy

    2011-01-01

    When planning a randomized clinical trial, careful consideration must be given to how participants are selected for various arms of a study. Selection and accidental bias may occur when participants are not assigned to study groups with equal probability. A simple random allocation scheme is a process by which each participant has equal likelihood of being assigned to treatment versus referent groups. However, by chance an unequal number of individuals may be assigned to each arm of the study and thus decrease the power to detect statistically significant differences between groups. Block randomization is a commonly used technique in clinical trial design to reduce bias and achieve balance in the allocation of participants to treatment arms, especially when the sample size is small. This method increases the probability that each arm will contain an equal number of individuals by sequencing participant assignments by block. Yet still, the allocation process may be predictable, for example, when the investigator is not blind and the block size is fixed. This paper provides an overview of blocked randomization and illustrates how to avoid selection bias by using random block sizes.

  5. Randomized selection on the GPU

    Energy Technology Data Exchange (ETDEWEB)

    Monroe, Laura Marie [Los Alamos National Laboratory; Wendelberger, Joanne R [Los Alamos National Laboratory; Michalak, Sarah E [Los Alamos National Laboratory

    2011-01-13

    We implement here a fast and memory-sparing probabilistic top N selection algorithm on the GPU. To our knowledge, this is the first direct selection in the literature for the GPU. The algorithm proceeds via a probabilistic-guess-and-chcck process searching for the Nth element. It always gives a correct result and always terminates. The use of randomization reduces the amount of data that needs heavy processing, and so reduces the average time required for the algorithm. Probabilistic Las Vegas algorithms of this kind are a form of stochastic optimization and can be well suited to more general parallel processors with limited amounts of fast memory.

  6. Random selection of Borel sets

    Directory of Open Access Journals (Sweden)

    Bernd Günther

    2010-10-01

    Full Text Available A theory of random Borel sets is presented, based on dyadic resolutions of compact metric spaces. The conditional expectation of the intersection of two independent random Borel sets is investigated. An example based on an embedding of Sierpinski’s universal curve into the space of Borel sets is given.

  7. Evaluation of the effect of aromatherapy with Rosa damascena Mill. on postoperative pain intensity in hospitalized children in selected hospitals affiliated to Isfahan University of Medical Sciences in 2013: A randomized clinical trial

    Science.gov (United States)

    Marofi, Maryam; Sirousfard, Motahareh; Moeini, Mahin; Ghanadi, Alireza

    2015-01-01

    Background: Pain is the common complication after a surgery. The aim of this study was to evaluate the effect of aromatherapy with Rosa damascena Mill. on the postoperative pain in children. Materials and Methods: In a double-blind, placebo-controlled clinical trial, we selected 64 children of 3–6 years of age through convenient sampling and divided them randomly into two groups. Patients in group A were given inhalation aromatherapy with R. damascena Mill., and in group B, the patients were given almond oil as a placebo. Inhalation aromatherapy was used at the first time of subjects’ arrival to the ward and then at 3, 6, 9, and 12 h afterward. Common palliative treatments to relieve pain were used in both groups. Thirty minutes after aromatherapy, the postoperative pain in children was evaluated with the Toddler Preschooler Postoperative Pain Scale (TPPPS). Data were statistically analyzed using Chi-square test, one-way analysis of variance (ANOVA), and repeated measures ANOVA. Results: There was no significant difference in pain scores at the first time of subjects’ arrival to the ward (before receiving any aromatherapy or palliative care) between the two groups. After each time of aromatherapy and at the end of treatment, the pain score was significantly reduced in the aromatherapy group with R. damascena Mill. compared to the placebo group. Conclusions: According to our results, aromatherapy with R. damascena Mill. can be used in postoperative pain in children, together with other common treatments without any significant side effects. PMID:25878704

  8. Evaluation of the effect of aromatherapy with Rosa damascena Mill. on postoperative pain intensity in hospitalized children in selected hospitals affiliated to Isfahan University of Medical Sciences in 2013: A randomized clinical trial.

    Science.gov (United States)

    Marofi, Maryam; Sirousfard, Motahareh; Moeini, Mahin; Ghanadi, Alireza

    2015-01-01

    Pain is the common complication after a surgery. The aim of this study was to evaluate the effect of aromatherapy with Rosa damascena Mill. on the postoperative pain in children. In a double-blind, placebo-controlled clinical trial, we selected 64 children of 3-6 years of age through convenient sampling and divided them randomly into two groups. Patients in group A were given inhalation aromatherapy with R. damascena Mill., and in group B, the patients were given almond oil as a placebo. Inhalation aromatherapy was used at the first time of subjects' arrival to the ward and then at 3, 6, 9, and 12 h afterward. Common palliative treatments to relieve pain were used in both groups. Thirty minutes after aromatherapy, the postoperative pain in children was evaluated with the Toddler Preschooler Postoperative Pain Scale (TPPPS). Data were statistically analyzed using Chi-square test, one-way analysis of variance (ANOVA), and repeated measures ANOVA. There was no significant difference in pain scores at the first time of subjects' arrival to the ward (before receiving any aromatherapy or palliative care) between the two groups. After each time of aromatherapy and at the end of treatment, the pain score was significantly reduced in the aromatherapy group with R. damascena Mill. compared to the placebo group. According to our results, aromatherapy with R. damascena Mill. can be used in postoperative pain in children, together with other common treatments without any significant side effects.

  9. Species selection and random drift in macroevolution.

    Science.gov (United States)

    Chevin, Luis-Miguel

    2016-03-01

    Species selection resulting from trait-dependent speciation and extinction is increasingly recognized as an important mechanism of phenotypic macroevolution. However, the recent bloom in statistical methods quantifying this process faces a scarcity of dynamical theory for their interpretation, notably regarding the relative contributions of deterministic versus stochastic evolutionary forces. I use simple diffusion approximations of birth-death processes to investigate how the expected and random components of macroevolutionary change depend on phenotype-dependent speciation and extinction rates, as can be estimated empirically. I show that the species selection coefficient for a binary trait, and selection differential for a quantitative trait, depend not only on differences in net diversification rates (speciation minus extinction), but also on differences in species turnover rates (speciation plus extinction), especially in small clades. The randomness in speciation and extinction events also produces a species-level equivalent to random genetic drift, which is stronger for higher turnover rates. I then show how microevolutionary processes including mutation, organismic selection, and random genetic drift cause state transitions at the species level, allowing comparison of evolutionary forces across levels. A key parameter that would be needed to apply this theory is the distribution and rate of origination of new optimum phenotypes along a phylogeny. © 2016 The Author(s). Evolution © 2016 The Society for the Study of Evolution.

  10. Improving randomness characterization through Bayesian model selection.

    Science.gov (United States)

    Díaz Hernández Rojas, Rafael; Solís, Aldo; Angulo Martínez, Alí M; U'Ren, Alfred B; Hirsch, Jorge G; Marsili, Matteo; Pérez Castillo, Isaac

    2017-06-08

    Random number generation plays an essential role in technology with important applications in areas ranging from cryptography to Monte Carlo methods, and other probabilistic algorithms. All such applications require high-quality sources of random numbers, yet effective methods for assessing whether a source produce truly random sequences are still missing. Current methods either do not rely on a formal description of randomness (NIST test suite) on the one hand, or are inapplicable in principle (the characterization derived from the Algorithmic Theory of Information), on the other, for they require testing all the possible computer programs that could produce the sequence to be analysed. Here we present a rigorous method that overcomes these problems based on Bayesian model selection. We derive analytic expressions for a model's likelihood which is then used to compute its posterior distribution. Our method proves to be more rigorous than NIST's suite and Borel-Normality criterion and its implementation is straightforward. We applied our method to an experimental device based on the process of spontaneous parametric downconversion to confirm it behaves as a genuine quantum random number generator. As our approach relies on Bayesian inference our scheme transcends individual sequence analysis, leading to a characterization of the source itself.

  11. 32 CFR 1624.1 - Random selection procedures for induction.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Random selection procedures for induction. 1624... SYSTEM INDUCTIONS § 1624.1 Random selection procedures for induction. (a) The Director of Selective Service shall from time to time establish a random selection sequence for induction by a drawing to be...

  12. Assessment of pharmaceutical waste management at selected hospitals and homes in Ghana.

    Science.gov (United States)

    Sasu, Samuel; Kümmerer, Klaus; Kranert, Martin

    2012-06-01

    The practice of use and disposal of waste from pharmaceuticals compromises the safety of the environment as well as representing a serious health risk, as they may accumulate and stay active for a long time in the aquatic environment. This article therefore presents the outcome of a study on pharmaceutical waste management practices at homes and hospitals in Ghana. The study was conducted at five healthcare institutions randomly selected in Ghana, namely two teaching hospitals (hospital A, hospital B), one regional hospital (hospital C), one district hospital (hospital D) and one quasi-governmental hospital (hospital E). Apart from hospital E which currently has a pharmaceutical waste separation programmr as well as drug return programme called DUMP (Disposal of Unused Medicines Program), all other hospitals visited do not have any separate collection and disposal programme for pharmaceutical waste. A survey was also carried out among the general public, involving the questioning of randomly selected participants in order to investigate the household disposal of unused and expired pharmaceuticals. The results from the survey showed that more than half of the respondents confirmed having unused, left-over or expired medicines at home and over 75% disposed of pharmaceutical waste through the normal waste bins which end up in the landfills or dump sites.

  13. Selecting public relations personnel of hospitals by analytic network process.

    Science.gov (United States)

    Liao, Sen-Kuei; Chang, Kuei-Lun

    2009-01-01

    This study describes the use of analytic network process (ANP) in the Taiwanese hospital public relations personnel selection process. Starting with interviewing 48 practitioners and executives in north Taiwan, we collected selection criteria. Then, we retained the 12 critical criteria that were mentioned above 40 times by theses respondents, including: interpersonal skill, experience, negotiation, language, ability to follow orders, cognitive ability, adaptation to environment, adaptation to company, emotion, loyalty, attitude, and Response. Finally, we discussed with the 20 executives to take these important criteria into three perspectives to structure the hierarchy for hospital public relations personnel selection. After discussing with practitioners and executives, we find that selecting criteria are interrelated. The ANP, which incorporates interdependence relationships, is a new approach for multi-criteria decision-making. Thus, we apply ANP to select the most optimal public relations personnel of hospitals. An empirical study of public relations personnel selection problems in Taiwan hospitals is conducted to illustrate how the selection procedure works.

  14. infected subjects attending three selected hospitals

    African Journals Online (AJOL)

    USER

    2015-06-01

    Jun 1, 2015 ... and Infectious Diseases Hospital. HIV infection was confirmed using indirect ... HIV infection affects the serum levels of iron, vitamin A and β-carotene by reducing their levels; hence, dietary supplementation with ... include vitamins such as vitamin A, D, E, K, B and C and minerals such as Iron, iodine, zinc, ...

  15. In-Place Randomized Slope Selection

    DEFF Research Database (Denmark)

    Blunck, Henrik; Vahrenhold, Jan

    2006-01-01

    Slope selection is a well-known algorithmic tool used in the context of computing robust estimators for fitting a line to a collection P of n points in the plane. We demonstrate that it is possible to perform slope selection in expected O(nlogn) time using only constant extra space in addition to...

  16. Random effect selection in generalised linear models

    DEFF Research Database (Denmark)

    Denwood, Matt; Houe, Hans; Forkman, Björn

    We analysed abattoir recordings of meat inspection codes with possible relevance to onfarm animal welfare in cattle. Random effects logistic regression models were used to describe individual-level data obtained from 461,406 cattle slaughtered in Denmark. Our results demonstrate that the largest ...

  17. Randomized clinical trial of nutritional counseling for malnourished hospital patients.

    Science.gov (United States)

    Casals, C; García-Agua-Soler, N; Vázquez-Sánchez, M Á; Requena-Toro, M V; Padilla-Romero, L; Casals-Sánchez, J L

    2015-01-01

    Malnutrition is associated with an increased risk of mortality and morbidity, longer hospital stays and general loss of quality of life. The aim of this study is to assess the impact of dietary counseling for malnourished hospital patients. Prospective, randomized, open-label study of 106 hospital patients with malnutrition (54 in the control group and 52 in the intervention group). The intervention group received dietary counseling, and the control group underwent standard treatment. We determined the patients' nutritional state (body mass index, laboratory parameters, malnutrition universal screening tool), degree of dependence (Barthel index), quality of life (SF-12), degree of satisfaction (CSQ-8), the number and length of readmissions and mortality. The patients who underwent the "intervention" increased their weight at 6 months, while the controls lost weight (difference in body mass index, 2.14kg/m(2); p<.001). The intervention group had better results when compared with the control group in the Malnutrition Universal Screening Tool scores (difference, -1.29; p<.001), Barthel index (difference, 7.49; p=.025), SF-12 (difference, 13.72; p<.001) and CSQ-8 (difference, 4.34, p<.001) and required fewer readmissions (difference, -0.37; p=.04) and shorter stays for readmissions (difference, -6.75; p=.035). Mortality and laboratory parameters were similar for the 2 groups. Nutritional counseling improved the patients' nutritional state, quality of life and degree of dependence and decreased the number of hospital readmissions. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  18. Sequential selection of random vectors under a sum constraint

    OpenAIRE

    Stanke, Mario

    2004-01-01

    We observe a sequence X1,X2,...,Xn of independent and identically distributed coordinatewise nonnegative d-dimensional random vectors. When a vector is observed it can either be selected or rejected but once made this decision is final. In each coordinate the sum of the selected vectors must not exceed a given constant. The problem is to find a selection policy that maximizes the expected number of selected vectors. For a general absolutely continuous distribution of t...

  19. Stroke rehabilitation after hospital discharge: a randomized trial comparing domiciliary and day-hospital care.

    Science.gov (United States)

    Roderick, P; Low, J; Day, R; Peasgood, T; Mullee, M A; Turnbull, J C; Villar, T; Raftery, J

    2001-07-01

    To compare the effectiveness and costs of a new domiciliary rehabilitation service for elderly stroke patients with geriatric day-hospital care. Randomized controlled trial. Stroke patients aged 55+ who required further rehabilitation after hospital discharge or after referral to geriatricians from the community. Poole area, East Dorset, a mixed urban/rural area on the south coast of England. Primary-changes between hospital discharge and 6-month follow-up in physical function as measured by Barthel index. Secondary-changes over this period in Rivermead Mobility Index and mental state (Philadelphia Geriatric Centre Morale Scale) and differences in social activity (Frenchay Activities Index) and generic health status (SF-36). Health service and social service cost per patient were compared for the two groups. 180 patients were eligible and 140 (78%) were randomized. The groups were well balanced for age, sex, social class and initial Barthel index. We achieved follow-up in 88% of subjects who were alive at 6 months. We detected no significant differences in patient outcomes, although there was a non-significant improvement in measures of physical function and social activity in the domiciliary group. Domiciliary patients had more physiotherapy time per session and more district nurse time, and made greater use of social service day centres and home helps. Total cost per patient did not differ significantly between the two groups, with reduced health service costs in the domiciliary arm offset by higher social service costs. No significant differences were detected in the effectiveness of the two services. Neither service influenced patients' mental state, and their social activity remained low. Total costs were similar. A mixed model of day-hospital and domiciliary care may be most cost-effective for community stroke rehabilitation, but this requires further evaluation.

  20. Selectivity and sparseness in randomly connected balanced networks.

    Directory of Open Access Journals (Sweden)

    Cengiz Pehlevan

    Full Text Available Neurons in sensory cortex show stimulus selectivity and sparse population response, even in cases where no strong functionally specific structure in connectivity can be detected. This raises the question whether selectivity and sparseness can be generated and maintained in randomly connected networks. We consider a recurrent network of excitatory and inhibitory spiking neurons with random connectivity, driven by random projections from an input layer of stimulus selective neurons. In this architecture, the stimulus-to-stimulus and neuron-to-neuron modulation of total synaptic input is weak compared to the mean input. Surprisingly, we show that in the balanced state the network can still support high stimulus selectivity and sparse population response. In the balanced state, strong synapses amplify the variation in synaptic input and recurrent inhibition cancels the mean. Functional specificity in connectivity emerges due to the inhomogeneity caused by the generative statistical rule used to build the network. We further elucidate the mechanism behind and evaluate the effects of model parameters on population sparseness and stimulus selectivity. Network response to mixtures of stimuli is investigated. It is shown that a balanced state with unselective inhibition can be achieved with densely connected input to inhibitory population. Balanced networks exhibit the "paradoxical" effect: an increase in excitatory drive to inhibition leads to decreased inhibitory population firing rate. We compare and contrast selectivity and sparseness generated by the balanced network to randomly connected unbalanced networks. Finally, we discuss our results in light of experiments.

  1. Risk assessment - hospital view in selecting medical technology.

    Science.gov (United States)

    David, Yadin; Jahnke, Ernest; Blair, Curtis

    2004-01-01

    Appropriate deployment of technological innovation contributes to improvement in the quality of healthcare delivered, the containment of cost, and access to the healthcare system. Hospitals have been allocating a significant portion of their resources to procuring and managing capital assets; they are continuously faced with demands for new medical equipment and are asked to manage existing inventory for which they are not well prepared. To objectively direct their investment, hospitals are developing medical technology management programs that need pertinent information and planning methodology for integrating new equipment into existing operations as well as for mitigating patient safety issues and costs of ownership. Clinical engineers identify technological solutions based on the matching of new medical equipment with hospital's objectives. They review their institution's overall technological position, determine strengths and weaknesses, develop equipment-selection criteria, supervise installations, train users and monitor post procurement performance to assure meeting of goals. This program, together with consistent assessment methodology and evaluation analysis, will objectively guide the capital assets decision-making process. At Texas Children's Hospital we integrated engineering simulation, bench testing and clinical studies with financial information to assure the validity of risk avoidance practice and the promotion of medical equipment and supplies selection based on quantitative measurement process and product comparison practice. The clinical engineer's skills and expertise are needed to facilitate the adoption of an objective methodology for implementing the program, thus improving the match between the hospital's needs and budget projections, equipment performance and cost of ownership. The result of systematic planning and execution is a program that assures the safety and appropriateness of inventory level at the lowest life-cycle costs at the

  2. Technology diffusion in hospitals : A log odds random effects regression model

    NARCIS (Netherlands)

    Blank, J.L.T.; Valdmanis, V.G.

    2013-01-01

    This study identifies the factors that affect the diffusion of hospital innovations. We apply a log odds random effects regression model on hospital micro data. We introduce the concept of clustering innovations and the application of a log odds random effects regression model to describe the

  3. Technology diffusion in hospitals: A log odds random effects regression model

    NARCIS (Netherlands)

    J.L.T. Blank (Jos); V.G. Valdmanis (Vivian G.)

    2015-01-01

    textabstractThis study identifies the factors that affect the diffusion of hospital innovations. We apply a log odds random effects regression model on hospital micro data. We introduce the concept of clustering innovations and the application of a log odds random effects regression model to

  4. Knowledge on Hospital Waste Management among Senior Staff Nurses Working in a Selected Medical College Hospital of Bangladesh

    Directory of Open Access Journals (Sweden)

    Mohammad Nasir Uddin

    2014-01-01

    Full Text Available Background. Healthcare wastes include all types of wastes generated by healthcare establishments. Waste disposal problem is growing with an ever-increasing number of hospitals, clinics, and diagnostic laboratories in Bangladesh and also in Faridpur town. Aim and Objective. The outcomes of this study will contribute to increase proper waste management practice among nurses in Bangladesh. Methods. A descriptive type of cross sectional study design was used to assess the level of knowledge regarding hospital waste management among senior staff nurses working in Faridpur Medical College Hospital, Bangladesh. All respondents (n=125 were selected by random sampling. Results. In the answer of knowledge about general waste only 4% (n=5 gave all correct answers. In the answer of knowledge about infectious waste 63.2% (n=79 gave one correct answer, of knowledge about pharmaceutical waste only 8% (n=10 gave all correct answers, and of knowledge about biomedical waste only 7.2% (n=9 gave all correct answers. In the answer of knowledge about color coded bins collecting waste 53.6% (n=67 cannot give any correct answer and only 46.4% (n=58 gave all correct answers and of knowledge about the safe disposal of hospital waste 16% (n=8 could not give any correct answer. However, against all questions were 5 options. Conclusion. Knowledge about hospital waste and its management is very poor among senior staff nurses. As a recommendation to improve this situation continuous training should be made compulsory for healthcare personnel specially staff nurses working in Bangladesh.

  5. Fast, Randomized Join-Order Selection - Why Use Transformations?

    NARCIS (Netherlands)

    C.A. Galindo-Legaria; A.J. Pellenkoft (Jan); M.L. Kersten (Martin)

    1994-01-01

    textabstractWe study the effectiveness of probabilistic selection of join-query evaluation plans, without reliance on tree transformation rules. Instead, each candidate plan is chosen uniformly at random from the space of valid evaluation orders. This leads to a transformation-free strategy where a

  6. The reliability of randomly selected final year pharmacy students in ...

    African Journals Online (AJOL)

    Employing ANOVA, factorial experimental analysis, and the theory of error, reliability studies were conducted on the assessment of the drug product chloroquine phosphate tablets. The G–Study employed equal numbers of the factors for uniform control, and involved three analysts (randomly selected final year Pharmacy ...

  7. Local randomization in neighbor selection improves PRM roadmap quality

    KAUST Repository

    McMahon, Troy

    2012-10-01

    Probabilistic Roadmap Methods (PRMs) are one of the most used classes of motion planning methods. These sampling-based methods generate robot configurations (nodes) and then connect them to form a graph (roadmap) containing representative feasible pathways. A key step in PRM roadmap construction involves identifying a set of candidate neighbors for each node. Traditionally, these candidates are chosen to be the k-closest nodes based on a given distance metric. In this paper, we propose a new neighbor selection policy called LocalRand(k,K\\'), that first computes the K\\' closest nodes to a specified node and then selects k of those nodes at random. Intuitively, LocalRand attempts to benefit from random sampling while maintaining the higher levels of local planner success inherent to selecting more local neighbors. We provide a methodology for selecting the parameters k and K\\'. We perform an experimental comparison which shows that for both rigid and articulated robots, LocalRand results in roadmaps that are better connected than the traditional k-closest policy or a purely random neighbor selection policy. The cost required to achieve these results is shown to be comparable to k-closest. © 2012 IEEE.

  8. Factor selection for service quality evaluation: a hospital case study.

    Science.gov (United States)

    Ameryoun, Ahmad; Najafi, Seyedvahid; Nejati-Zarnaqi, Bayram; Khalilifar, Seyed Omid; Ajam, Mahdi; Ansarimoghadam, Ahmad

    2017-02-13

    Purpose The purpose of this paper is to develop a systematic approach to predict service quality dimension's influence on service quality using a novel analysis based on data envelopment and SERVQUAL. Design/methodology/approach To assess hospital service quality in Tehran, expectation and perception of those who received the services were evaluated using SERVQUAL. The hospital service quality dimensions were found by exploratory factor analysis (EFA). To compare customer expectation and perception, perceived service quality index (PSQI) was measured using a new method based on common weights. A novel sensitivity approach was used to test the service quality factor's impact on the PSQI. Findings A new service quality dimension named "trust in services" was found using EFA, which is not an original SERVQUAL factor. The approach was applied to assess the hospital's service quality. Since the PSQI value was 0.76 it showed that improvements are needed to meet customer expectations. The results showed the factor order that affect PSQI. "Trust in services" has the strongest influence on PSQI followed by "tangibles," "assurance," "empathy," and "responsiveness," respectively. Practical implications This work gives managers insight into service quality by following a systematic method; i.e., measuring perceived service quality from the customer viewpoint and service factors' impact on customer perception. Originality/value The procedure helps managers to select the required service quality dimensions which need improvement and predict their effects on customer perception.

  9. Selecting a phoneme-to-grapheme mapping: Random or weighted selection?

    Directory of Open Access Journals (Sweden)

    Binna Lee

    2015-05-01

    Our findings demonstrate that random selection underestimates MOA’s PG correspondences whereas weighted selection predicts higher PG correspondences than he produces. To explain his intermediate spelling performance on PPEs, we will test additional approaches to weighing the relative probability of PG mappings, including using log frequencies, separating consonant and vowel status, and considering the number of grapheme options in each phoneme.

  10. Predictors of postdischarge outcomes from information acquired shortly after admission for acute heart failure: a report from the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT) Study.

    Science.gov (United States)

    Cleland, John G; Chiswell, Karen; Teerlink, John R; Stevens, Susanna; Fiuzat, Mona; Givertz, Michael M; Davison, Beth A; Mansoor, George A; Ponikowski, Piotr; Voors, Adriaan A; Cotter, Gad; Metra, Marco; Massie, Barry M; O'Connor, Christopher M

    2014-01-01

    Acute heart failure is a common reason for admission, and outcome is often poor. Improved prognostic risk stratification may assist in the design of future trials and in patient management. Using data from a large randomized trial, we explored the prognostic value of clinical variables, measured at hospital admission for acute heart failure, to determine whether a few selected variables were inferior to an extended data set. The prognostic model included 37 clinical characteristics collected at baseline in PROTECT, a study comparing rolofylline and placebo in 2033 patients admitted with acute heart failure. Prespecified outcomes at 30 days were death or rehospitalization for any reason; death or rehospitalization for cardiovascular or renal reasons; and, at both 30 and 180 days, all-cause mortality. No variable had a c-index>0.70, and few had values>0.60; c-indices were lower for composite outcomes than for mortality. Blood urea was generally the strongest single predictor. Eighteen variables contributed independent prognostic information, but a reduced model using only 8 items (age, previous heart failure hospitalization, peripheral edema, systolic blood pressure, serum sodium, urea, creatinine, and albumin) performed similarly. For prediction of all-cause mortality at 180 days, the model c-index using all variables was 0.72 and for the simplified model, also 0.72. A few simple clinical variables measured on admission in patients with acute heart failure predict a variety of adverse outcomes with accuracy similar to more complex models. However, predictive models were of only moderate accuracy, especially for outcomes that included nonfatal events. Better methods of risk stratification are required. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00328692 and NCT00354458.

  11. Selection for altruism through random drift in variable size populations.

    Science.gov (United States)

    Houchmandzadeh, Bahram; Vallade, Marcel

    2012-05-10

    Altruistic behavior is defined as helping others at a cost to oneself and a lowered fitness. The lower fitness implies that altruists should be selected against, which is in contradiction with their widespread presence is nature. Present models of selection for altruism (kin or multilevel) show that altruistic behaviors can have 'hidden' advantages if the 'common good' produced by altruists is restricted to some related or unrelated groups. These models are mostly deterministic, or assume a frequency dependent fitness. Evolutionary dynamics is a competition between deterministic selection pressure and stochastic events due to random sampling from one generation to the next. We show here that an altruistic allele extending the carrying capacity of the habitat can win by increasing the random drift of "selfish" alleles. In other terms, the fixation probability of altruistic genes can be higher than those of a selfish ones, even though altruists have a smaller fitness. Moreover when populations are geographically structured, the altruists advantage can be highly amplified and the fixation probability of selfish genes can tend toward zero. The above results are obtained both by numerical and analytical calculations. Analytical results are obtained in the limit of large populations. The theory we present does not involve kin or multilevel selection, but is based on the existence of random drift in variable size populations. The model is a generalization of the original Fisher-Wright and Moran models where the carrying capacity depends on the number of altruists.

  12. Selection for altruism through random drift in variable size populations

    Directory of Open Access Journals (Sweden)

    Houchmandzadeh Bahram

    2012-05-01

    Full Text Available Abstract Background Altruistic behavior is defined as helping others at a cost to oneself and a lowered fitness. The lower fitness implies that altruists should be selected against, which is in contradiction with their widespread presence is nature. Present models of selection for altruism (kin or multilevel show that altruistic behaviors can have ‘hidden’ advantages if the ‘common good’ produced by altruists is restricted to some related or unrelated groups. These models are mostly deterministic, or assume a frequency dependent fitness. Results Evolutionary dynamics is a competition between deterministic selection pressure and stochastic events due to random sampling from one generation to the next. We show here that an altruistic allele extending the carrying capacity of the habitat can win by increasing the random drift of “selfish” alleles. In other terms, the fixation probability of altruistic genes can be higher than those of a selfish ones, even though altruists have a smaller fitness. Moreover when populations are geographically structured, the altruists advantage can be highly amplified and the fixation probability of selfish genes can tend toward zero. The above results are obtained both by numerical and analytical calculations. Analytical results are obtained in the limit of large populations. Conclusions The theory we present does not involve kin or multilevel selection, but is based on the existence of random drift in variable size populations. The model is a generalization of the original Fisher-Wright and Moran models where the carrying capacity depends on the number of altruists.

  13. [Selection criteria of mobile lifters in the hospital setting].

    Science.gov (United States)

    Ferriero, G; Ottonello, M; Franchignoni, F

    2002-01-01

    The manual handling of patients with limited mobility represents the major cause of musculoskeletal injury to the spine in paramedical health care workers. Within the hospital, the more complex procedures of patient transfer often require the use of mobile hoists. The aim of this paper is to describe the basic criteria for the selection of such hoists. The main characteristics of a hoist are its stability, the sling attachment, the speed of operation, range of movement of the spreader bar, safety of the operation being performed, patient comfort, the physical effort required on the part of the health care worker, manoeuvrability and simplicity of use. Important organizational-structural features to evaluate include: the type of patient normally present in the unit concerned, the specific movement to be performed, the structural characteristics of the environment, and the work organization of the personnel.

  14. Patients' Expectations and Perceptions of Service Quality in the Selected Hospitals.

    Science.gov (United States)

    Nadi, Aliasghar; Shojaee, Jalil; Abedi, Ghassem; Siamian, Hasan; Abedini, Ehsan; Rostami, Farideh

    2016-04-01

    Hospital's success depends on patients' expectations, perceptions, and judgment on the quality of services provided by hospitals. This study was conducted to assess the patients' perceptions and expectations from the quality of inpatient health care in Vali-Asr hospital, Ghaemshahr, and Imam Khomeini and Shafa Hospitals, Sari. This study is applied regarding the objective of the study. Considering the research methodology, it is a descriptive - analytical study. The sample of this study consists of 600 patients with at least 24 hours of being hospitalized in internal, surgery, women, and children sectors of Vali-Asr, Ghaemshahr, Imam Khomeini, and Shafa Hospitals. Using random sampling method, the classifications relevant to the size of each class were selected. The data required was collected through the standard SERVQUAL questionnaire and then it was analyzed using the SPSS software. The overall mean value and standard deviation of expectations were equal to 10.4 and 28, respectively. The mean value for the field of perception was 69.2 and the relevant standard deviation was 26. In terms of patients and hospital visits in concrete cases, the highest priority is related to empathy. The second priority is related to physical appearance, the third priority is related to responsiveness, the fourth priority is related to assurance, and the lowest priority is related to the reliability of the SERVQUAL approach. Examining the gap between patients' perceptions and expectations, the widest gap was observed in the Vali-Asr Hospital with the mean and SD (-92.0±39.0) and the lowest gap was observed in Shafa Hospital with the mean value of (-39.9±44.0). According to The Kruskal-Wallis test, the difference observed in these three hospitals were significant. The results showed that patients' expectations had not been met in any of the examined dimensions and their consent has not been achieved. It seemed that necessary for managers and relevant authorities to plan and pay

  15. Interference-aware random beam selection for spectrum sharing systems

    KAUST Repository

    Abdallah, Mohamed M.

    2012-09-01

    Spectrum sharing systems have been introduced to alleviate the problem of spectrum scarcity by allowing secondary unlicensed networks to share the spectrum with primary licensed networks under acceptable interference levels to the primary users. In this paper, we develop interference-aware random beam selection schemes that provide enhanced throughput for the secondary link under the condition that the interference observed at the primary link is within a predetermined acceptable value. For a secondary transmitter equipped with multiple antennas, our schemes select a random beam, among a set of power- optimized orthogonal random beams, that maximizes the capacity of the secondary link while satisfying the interference constraint at the primary receiver for different levels of feedback information describing the interference level at the primary receiver. For the proposed schemes, we develop a statistical analysis for the signal-to-noise and interference ratio (SINR) statistics as well as the capacity of the secondary link. Finally, we present numerical results that study the effect of system parameters including number of beams and the maximum transmission power on the capacity of the secondary link attained using the proposed schemes. © 2012 IEEE.

  16. Molecular characterization of rotavirus isolates from select Canadian pediatric hospitals

    Directory of Open Access Journals (Sweden)

    McDermid Andrew

    2012-11-01

    Full Text Available Abstract Background We report the first multi-site rotavirus genotype analysis in Canada. Prior to this study, there was a dearth of rotavirus G and P genotyping data in Canada. Publically funded universal rotavirus vaccination in Canada started in 2011 and has been introduced by four provinces to date. Uptake of rotavirus vaccines in Canada prior to 2012 has been very limited. The aim of this study was to describe the genotypes of rotavirus strains circulating in Canada prior to widespread implementation of rotavirus vaccine by genotyping samples collected from selected paediatric hospitals. Secondly we identified rotavirus strains that differed genetically from those included in the vaccines and which could affect vaccine effectiveness. Methods Stool specimens were collected by opportunity sampling of children with gastroenteritis who presented to emergency departments. Samples were genotyped for G (VP7 genotypes and P (VP4 genotypes by hemi-nested multiplex PCR methods. Phylogenetic analysis was carried out on Canadian G9 strains to investigate their relationship to G9 strains that have circulated in other regions of the world. Results 348 samples were collected, of which 259 samples were rotavirus positive and genotyped. There were 34 rotavirus antigen immunoassay negative samples genotyped using PCR-based methods. Over the four rotavirus seasons, 174 samples were G1P[8], 45 were G3P[8], 22 were G2P[4], 13 were G9P[8], 3 were G4P[8] and 2 were G9P[4]. Sequence analysis showed that all Canadian G9 isolates are within lineage III. Conclusions Although a limited number of samples were obtained from a median of 4 centres during the 4 years of the study, it appears that currently approved rotavirus vaccines are well matched to the rotavirus genotypes identified at these hospitals. Further surveillance to monitor the emergence of rotavirus genotypes in Canada is warranted.

  17. Molecular characterization of rotavirus isolates from select Canadian pediatric hospitals

    Science.gov (United States)

    2012-01-01

    Background We report the first multi-site rotavirus genotype analysis in Canada. Prior to this study, there was a dearth of rotavirus G and P genotyping data in Canada. Publically funded universal rotavirus vaccination in Canada started in 2011 and has been introduced by four provinces to date. Uptake of rotavirus vaccines in Canada prior to 2012 has been very limited. The aim of this study was to describe the genotypes of rotavirus strains circulating in Canada prior to widespread implementation of rotavirus vaccine by genotyping samples collected from selected paediatric hospitals. Secondly we identified rotavirus strains that differed genetically from those included in the vaccines and which could affect vaccine effectiveness. Methods Stool specimens were collected by opportunity sampling of children with gastroenteritis who presented to emergency departments. Samples were genotyped for G (VP7) genotypes and P (VP4) genotypes by hemi-nested multiplex PCR methods. Phylogenetic analysis was carried out on Canadian G9 strains to investigate their relationship to G9 strains that have circulated in other regions of the world. Results 348 samples were collected, of which 259 samples were rotavirus positive and genotyped. There were 34 rotavirus antigen immunoassay negative samples genotyped using PCR-based methods. Over the four rotavirus seasons, 174 samples were G1P[8], 45 were G3P[8], 22 were G2P[4], 13 were G9P[8], 3 were G4P[8] and 2 were G9P[4]. Sequence analysis showed that all Canadian G9 isolates are within lineage III. Conclusions Although a limited number of samples were obtained from a median of 4 centres during the 4 years of the study, it appears that currently approved rotavirus vaccines are well matched to the rotavirus genotypes identified at these hospitals. Further surveillance to monitor the emergence of rotavirus genotypes in Canada is warranted. PMID:23153184

  18. Hospital Staff and Patient Recognition Toward Opening of Medical Services Market, and Factors in Selecting a Foreign Hospital

    OpenAIRE

    Ryu, Hyang Jin; Park, Eun Cheol; Sohn, Tae Yong; Yu, Seung Hum

    2007-01-01

    Purpose The objectives of this study are to compare the hospital employees' and patients' recognition and attitudes toward the opening of the medical services market, to analyze the differences between hospital employees and patients on the factors in selecting a foreign hospital. Materials and Methods This study collected and analyzed data using systematic questionnaires that were self-administered by employees and outpatients to compare their recognition of the opening of the medical servic...

  19. Technical efficiency of selected hospitals in Eastern Ethiopia.

    Science.gov (United States)

    Ali, Murad; Debela, Megersa; Bamud, Tewfik

    2017-12-01

    This study examines the relative technical efficiency of 12 hospitals in Eastern Ethiopia. Using six-year-round panel data for the period between 2007/08 and 2012/13, this study examines the technical efficiency, total factor productivity, and determinants of the technical inefficiency of hospitals. Data envelopment analysis (DEA) and DEA- based Malmquist productivity index used to estimate relative technical efficiency, scale efficiency, and total factor productivity index of hospitals. Tobit model used to examine the determinants of the technical inefficiency of hospitals. The DEA Variable Returns to Scale (VRS) estimate indicated that 6 (50%), 5 (42%), 3 (25%), 3 (25%), 4 (33%), and 3 (25%) of the hospitals were technically inefficient while 9 (75%), 9 (75%), 7 (58%), 7 (58%), 7 (58%) and 8 (67%) of hospitals were scale inefficient between 2007/08 and 2012/13, respectively. On average, Malmquist Total Factor Productivity (MTFP) of the hospitals decreased by 3.6% over the panel period. The Tobit model shows that teaching hospital is less efficiency than other hospitals. The Tobit regression model further shows that medical doctor to total staff ratio, the proportion of outpatient visit to inpatient days, and the proportion of inpatients treated per medical doctor were negatively related with technical inefficiency of hospitals. Hence, policy interventions that help utilize excess capacity of hospitals, increase doctor to other staff ratio, and standardize number of inpatients treated per doctor would contribute to the improvement of the technical efficiency of hospitals.

  20. Hospital Waste Management as a Potential Hazard in Selected ...

    African Journals Online (AJOL)

    The operations of health facilities generate waste; a common characteristic of hospitals and Primary Healthcare centres. However, improper handling of hospital waste constitutes potential risks to the environment and human health. Unfortunately, hospital waste management is not yet carried out with a satisfactory level of ...

  1. Factors associated with induced abortion at selected hospitals in the Volta Region, Ghana.

    Science.gov (United States)

    Klutsey, Ellen Eyi; Ankomah, Augustine

    2014-01-01

    Induced abortion rates remained persistently high in the Volta Region of Ghana in the 5 years from 2006 to 2011. Some hospitals, both rural and urban, report induced abortion-related complications as one of the top ten conditions in hospital admissions. This study explored demographic and other factors associated with induced abortion, and also assessed awareness of abortion-related complications among women of reproductive age in the Volta Region. A quantitative, hospital-based, unmatched case-control study was performed. The Volta Region was stratified into two health administration zones, ie, north and south. For each zone, hospitals were stratified into government and private hospitals. Employing simple random sampling, one private and three government hospitals were selected from each zone. This study is therefore based on eight hospitals, ie, six government hospitals and two private hospitals. Marital status, employment status, number of total pregnancies, and knowledge about contraception were found to be associated with induced abortion. Multiple logistic regression showed a 4% reduction in the odds of induced abortion in married women compared with women who were single (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.07-0.22). Unemployed women of reproductive age were found to be 0.35 times less likely to seek induced abortion compared with their employed counterparts (OR 0.35, CI 0.19-0.65). It was also observed that women with their second pregnancies were 3.8 times more likely to seek induced abortion and women with more than two pregnancies were 6.6 times more likely to do so (OR 3.81, CI 1.94-7.49 and OR 6.58, CI 2.58-16.79, respectively). Women with no knowledge of contraceptive methods were 4.6 times likely to seek induced abortion (OR 4.64, CI 1.39-15.4). Compared with women who had not had induced abortion, women with a high number of pregnancies and no contraceptive knowledge were more likely to have induced abortion. It was found that lack

  2. Patients’ Expectations and Perceptions of Service Quality in the Selected Hospitals

    Science.gov (United States)

    Nadi, Aliasghar; Shojaee, Jalil; Abedi, Ghassem; Siamian, Hasan; Abedini, Ehsan; Rostami, Farideh

    2016-01-01

    Background: Hospital’s success depends on patients’ expectations, perceptions, and judgment on the quality of services provided by hospitals. This study was conducted to assess the patients’ perceptions and expectations from the quality of inpatient health care in Vali-Asr hospital, Ghaemshahr, and Imam Khomeini and Shafa Hospitals, Sari. Materials and Methods: This study is applied regarding the objective of the study. Considering the research methodology, it is a descriptive – analytical study. The sample of this study consists of 600 patients with at least 24 hours of being hospitalized in internal, surgery, women, and children sectors of Vali-Asr, Ghaemshahr, Imam Khomeini, and Shafa Hospitals. Using random sampling method, the classifications relevant to the size of each class were selected. The data required was collected through the standard SERVQUAL questionnaire and then it was analyzed using the SPSS software. Results: The overall mean value and standard deviation of expectations were equal to 10.4 and 28, respectively. The mean value for the field of perception was 69.2 and the relevant standard deviation was 26. In terms of patients and hospital visits in concrete cases, the highest priority is related to empathy. The second priority is related to physical appearance, the third priority is related to responsiveness, the fourth priority is related to assurance, and the lowest priority is related to the reliability of the SERVQUAL approach. Examining the gap between patients’ perceptions and expectations, the widest gap was observed in the Vali-Asr Hospital with the mean and SD (-92.0±39.0) and the lowest gap was observed in Shafa Hospital with the mean value of (-39.9±44.0). According to The Kruskal–Wallis test, the difference observed in these three hospitals were significant. Conclusion: The results showed that patients’ expectations had not been met in any of the examined dimensions and their consent has not been achieved. It seemed

  3. Factors associated with induced abortion at selected hospitals in the Volta Region, Ghana

    Science.gov (United States)

    Klutsey, Ellen Eyi; Ankomah, Augustine

    2014-01-01

    Background Induced abortion rates remained persistently high in the Volta Region of Ghana in the 5 years from 2006 to 2011. Some hospitals, both rural and urban, report induced abortion-related complications as one of the top ten conditions in hospital admissions. This study explored demographic and other factors associated with induced abortion, and also assessed awareness of abortion-related complications among women of reproductive age in the Volta Region. Methods A quantitative, hospital-based, unmatched case-control study was performed. The Volta Region was stratified into two health administration zones, ie, north and south. For each zone, hospitals were stratified into government and private hospitals. Employing simple random sampling, one private and three government hospitals were selected from each zone. This study is therefore based on eight hospitals, ie, six government hospitals and two private hospitals. Results Marital status, employment status, number of total pregnancies, and knowledge about contraception were found to be associated with induced abortion. Multiple logistic regression showed a 4% reduction in the odds of induced abortion in married women compared with women who were single (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.07–0.22). Unemployed women of reproductive age were found to be 0.35 times less likely to seek induced abortion compared with their employed counterparts (OR 0.35, CI 0.19–0.65). It was also observed that women with their second pregnancies were 3.8 times more likely to seek induced abortion and women with more than two pregnancies were 6.6 times more likely to do so (OR 3.81, CI 1.94–7.49 and OR 6.58, CI 2.58–16.79, respectively). Women with no knowledge of contraceptive methods were 4.6 times likely to seek induced abortion (OR 4.64, CI 1.39–15.4). Compared with women who had not had induced abortion, women with a high number of pregnancies and no contraceptive knowledge were more likely to have

  4. Unbiased split variable selection for random survival forests using maximally selected rank statistics.

    Science.gov (United States)

    Wright, Marvin N; Dankowski, Theresa; Ziegler, Andreas

    2017-04-15

    The most popular approach for analyzing survival data is the Cox regression model. The Cox model may, however, be misspecified, and its proportionality assumption may not always be fulfilled. An alternative approach for survival prediction is random forests for survival outcomes. The standard split criterion for random survival forests is the log-rank test statistic, which favors splitting variables with many possible split points. Conditional inference forests avoid this split variable selection bias. However, linear rank statistics are utilized by default in conditional inference forests to select the optimal splitting variable, which cannot detect non-linear effects in the independent variables. An alternative is to use maximally selected rank statistics for the split point selection. As in conditional inference forests, splitting variables are compared on the p-value scale. However, instead of the conditional Monte-Carlo approach used in conditional inference forests, p-value approximations are employed. We describe several p-value approximations and the implementation of the proposed random forest approach. A simulation study demonstrates that unbiased split variable selection is possible. However, there is a trade-off between unbiased split variable selection and runtime. In benchmark studies of prediction performance on simulated and real datasets, the new method performs better than random survival forests if informative dichotomous variables are combined with uninformative variables with more categories and better than conditional inference forests if non-linear covariate effects are included. In a runtime comparison, the method proves to be computationally faster than both alternatives, if a simple p-value approximation is used. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  5. SELECTING A MANAGEMENT SYSTEM HOSPITAL BY A METHOD MULTICRITERIA

    Directory of Open Access Journals (Sweden)

    Vitorino, Sidney L.

    2016-12-01

    Full Text Available The objective of this report is to assess how the multi-criteria method Analytic Hierarchy Process [HP] can help a hospital complex to choose a more suitable management system, known as Enterprise Resource Planning (ERP. The choice coated is very complex due to the novelty of the process of choosing and conflicts generated between areas that did not have a single view of organizational needs, generating a lot of pressure in the department responsible for implementing systems. To assist in this process, he was hired an expert consultant in decision-making and AHP, which in its role of facilitator, contributed to the criteria for system selection were defined, and the choice to occur within a consensual process. We used the study of a single case, based on two indepth interviews with the consultant and the project manager, and documents generated by the advisory and the tool that supported the method. The results of this analysis showed that the method could effectively collaborate in the system acquisition process, but knowledge of the problems of employees and senior management support, it was not used in new decisions of the organization. We conclude that this method contributed to the consensus in the procurement process, team commitment and engagement of those involved.

  6. Continuous exclusive breastfeeding and some related factors in the selected hospitals of Isfahan.

    Science.gov (United States)

    Esfahani, Mitra Savabi; Fathizadeh, Nahid

    2011-01-01

    Exclusive nutrition with breastfeeding is the health provider of the infant and mothers and its continuing would provide more advantages. Exclusive nutrition on different communities is affected by different factors. This study aimed to determine continuous exclusive breastfeeding and some of the related factors. This was a descriptive-analysis prospective study. The study population included all the breastfed mothers admitted in the obstetrics wards of the selected hospitals. Selecting the hospitals also was done randomly. Data collection tools included a questionnaire completed by 291 mothers. To obtain the data about breastfeeding duration, mothers were phone called at the first and sixth postpartum months. The collected data were analyzed using descriptive and analytical statistics and software SPSS. Estimation of mean and standard deviation of exclusive breastfeeding duration at the first and sixth months after the delivery, respectively, were 3.86 (0.55) and 23.67 (6.63) weeks. One month after the delivery, 93.1%, 6.2% and 0.7% of the mothers, respectively, had exclusive breastfeeding, breastfeeding with formula milk or other ingredients and discontinuation of breastfeeding; 6 months after the delivery, these values changed to 86.3, 12 and 1.7%, respectively. The most frequent period of breastfeeding discontinuation (6.9%) was related to 1-4 weeks. The results indicated that statistically there was a significant correlation between breastfeeding duration and age and the birth hospital. While the results of the study showed no association between breastfeeding duration and number of the children, duration of marriage, educational level and mothers' occupation. The findings of the present study represented a high continuous exclusive breastfeeding which perhaps was due to applied baby-friendly hospitals strategies. Furthermore, to prevent from discontinuation of exclusive breastfeeding, knowing the discontinuation time and its related factors, particularly the

  7. The signature of positive selection at randomly chosen loci.

    Science.gov (United States)

    Przeworski, Molly

    2002-03-01

    In Drosophila and humans, there are accumulating examples of loci with a significant excess of high-frequency-derived alleles or high levels of linkage disequilibrium, relative to a neutral model of a random-mating population of constant size. These are features expected after a recent selective sweep. Their prevalence suggests that positive directional selection may be widespread in both species. However, as I show here, these features do not persist long after the sweep ends: The high-frequency alleles drift to fixation and no longer contribute to polymorphism, while linkage disequilibrium is broken down by recombination. As a result, loci chosen without independent evidence of recent selection are not expected to exhibit either of these features, even if they have been affected by numerous sweeps in their genealogical history. How then can we explain the patterns in the data? One possibility is population structure, with unequal sampling from different subpopulations. Alternatively, positive selection may not operate as is commonly modeled. In particular, the rate of fixation of advantageous mutations may have increased in the recent past.

  8. Cluster randomized trials in comparative effectiveness research: randomizing hospitals to test methods for prevention of healthcare-associated infections.

    Science.gov (United States)

    Platt, Richard; Takvorian, Samuel U; Septimus, Edward; Hickok, Jason; Moody, Julia; Perlin, Jonathan; Jernigan, John A; Kleinman, Ken; Huang, Susan S

    2010-06-01

    The need for evidence about the effectiveness of therapeutics and other medical practices has triggered new interest in methods for comparative effectiveness research. Describe an approach to comparative effectiveness research involving cluster randomized trials in networks of hospitals, health plans, or medical practices with centralized administrative and informatics capabilities. We discuss the example of an ongoing cluster randomized trial to prevent methicillin-resistant Staphylococcus aureus (MRSA) infection in intensive care units (ICUs). The trial randomizes 45 hospitals to: (a) screening cultures of ICU admissions, followed by Contact Precautions if MRSA-positive, (b) screening cultures of ICU admissions followed by decolonization if MRSA-positive, or (c) universal decolonization of ICU admissions without screening. All admissions to adult ICUs. The primary outcome is MRSA-positive clinical cultures occurring >or=2 days following ICU admission. Secondary outcomes include blood and urine infection caused by MRSA (and, separately, all pathogens), as well as the development of resistance to decolonizing agents. Recruitment of hospitals is complete. Data collection will end in Summer 2011. This trial takes advantage of existing personnel, procedures, infrastructure, and information systems in a large integrated hospital network to conduct a low-cost evaluation of prevention strategies under usual practice conditions. This approach is applicable to many comparative effectiveness topics in both inpatient and ambulatory settings.

  9. Blind Measurement Selection: A Random Matrix Theory Approach

    KAUST Repository

    Elkhalil, Khalil

    2016-12-14

    This paper considers the problem of selecting a set of $k$ measurements from $n$ available sensor observations. The selected measurements should minimize a certain error function assessing the error in estimating a certain $m$ dimensional parameter vector. The exhaustive search inspecting each of the $n\\\\choose k$ possible choices would require a very high computational complexity and as such is not practical for large $n$ and $k$. Alternative methods with low complexity have recently been investigated but their main drawbacks are that 1) they require perfect knowledge of the measurement matrix and 2) they need to be applied at the pace of change of the measurement matrix. To overcome these issues, we consider the asymptotic regime in which $k$, $n$ and $m$ grow large at the same pace. Tools from random matrix theory are then used to approximate in closed-form the most important error measures that are commonly used. The asymptotic approximations are then leveraged to select properly $k$ measurements exhibiting low values for the asymptotic error measures. Two heuristic algorithms are proposed: the first one merely consists in applying the convex optimization artifice to the asymptotic error measure. The second algorithm is a low-complexity greedy algorithm that attempts to look for a sufficiently good solution for the original minimization problem. The greedy algorithm can be applied to both the exact and the asymptotic error measures and can be thus implemented in blind and channel-aware fashions. We present two potential applications where the proposed algorithms can be used, namely antenna selection for uplink transmissions in large scale multi-user systems and sensor selection for wireless sensor networks. Numerical results are also presented and sustain the efficiency of the proposed blind methods in reaching the performances of channel-aware algorithms.

  10. Pediatric selective mutism therapy: a randomized controlled trial.

    Science.gov (United States)

    Esposito, Maria; Gimigliano, Francesca; Barillari, Maria R; Precenzano, Francesco; Ruberto, Maria; Sepe, Joseph; Barillari, Umberto; Gimigliano, Raffaele; Militerni, Roberto; Messina, Giovanni; Carotenuto, Marco

    2017-10-01

    Selective mutism (SM) is a rare disease in children coded by DSM-5 as an anxiety disorder. Despite the disabling nature of the disease, there is still no specific treatment. The aims of this study were to verify the efficacy of six-month standard psychomotor treatment and the positive changes in lifestyle, in a population of children affected by SM. Randomized controlled trial registered in the European Clinical Trials Registry (EuDract 2015-001161-36). University third level Centre (Child and Adolescent Neuropsychiatry Clinic). Study population was composed by 67 children in group A (psychomotricity treatment) (35 M, mean age 7.84±1.15) and 71 children in group B (behavioral and educational counseling) (37 M, mean age 7.75±1.36). Psychomotor treatment was administered by trained child therapists in residential settings three times per week. Each child was treated for the whole period by the same therapist and all the therapists shared the same protocol. The standard psychomotor session length is of 45 minutes. At T0 and after 6 months (T1) of treatments, patients underwent a behavioral and SM severity assessment. To verify the effects of the psychomotor management, the Child Behavior Checklist questionnaire (CBCL) and Selective Mutism Questionnaire (SMQ) were administered to the parents. After 6 months of psychomotor treatment SM children showed a significant reduction among CBCL scores such as in social relations, anxious/depressed, social problems and total problems (Ppsychomotricity a safe and efficacy therapy for pediatric selective mutism.

  11. Firearm Injuries at Selected Hospitals in Kenya | Njeru | Annals of ...

    African Journals Online (AJOL)

    Results: Eight hundred and fifty two hospital admissions due to gun-shot injuries were recorded between 1997 – 2002 (average, 142 per year) representing 1.8% of all injury admissions, and 0.2% of total admissions at the two hospitals. There were 10 times more male admissions and 89.9% of those involved were in the ...

  12. Optimizing Event Selection with the Random Grid Search

    Energy Technology Data Exchange (ETDEWEB)

    Bhat, Pushpalatha C. [Fermilab; Prosper, Harrison B. [Florida State U.; Sekmen, Sezen [Kyungpook Natl. U.; Stewart, Chip [Broad Inst., Cambridge

    2017-06-29

    The random grid search (RGS) is a simple, but efficient, stochastic algorithm to find optimal cuts that was developed in the context of the search for the top quark at Fermilab in the mid-1990s. The algorithm, and associated code, have been enhanced recently with the introduction of two new cut types, one of which has been successfully used in searches for supersymmetry at the Large Hadron Collider. The RGS optimization algorithm is described along with the recent developments, which are illustrated with two examples from particle physics. One explores the optimization of the selection of vector boson fusion events in the four-lepton decay mode of the Higgs boson and the other optimizes SUSY searches using boosted objects and the razor variables.

  13. Selective oropharyngeal decontamination versus selective digestive decontamination in critically ill patients: a meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Zhao D

    2015-07-01

    Full Text Available Di Zhao,1,* Jian Song,2,* Xuan Gao,3 Fei Gao,4 Yupeng Wu,2 Yingying Lu,5 Kai Hou1 1Department of Neurosurgery, The First Hospital of Hebei Medical University, 2Department of Neurosurgery, 3Department of Neurology, The Second Hospital of Hebei Medical University, 4Hebei Provincial Procurement Centers for Medical Drugs and Devices, 5Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang People’s Republic of China *These authors contributed equally to this work Background: Selective digestive decontamination (SDD and selective oropharyngeal decontamination (SOD are associated with reduced mortality and infection rates among patients in intensive care units (ICUs; however, whether SOD has a superior effect than SDD remains uncertain. Hence, we conducted a meta-analysis of randomized controlled trials (RCTs to compare SOD with SDD in terms of clinical outcomes and antimicrobial resistance rates in patients who were critically ill. Methods: RCTs published in PubMed, Embase, and Web of Science were systematically reviewed to compare the effects of SOD and SDD in patients who were critically ill. Outcomes included day-28 mortality, length of ICU stay, length of hospital stay, duration of mechanical ventilation, ICU-acquired bacteremia, and prevalence of antibiotic-resistant Gram-negative bacteria. Results were expressed as risk ratio (RR with 95% confidence intervals (CIs, and weighted mean differences (WMDs with 95% CIs. Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies. Results: A total of four RCTs involving 23,822 patients met the inclusion criteria and were included in this meta-analysis. Among patients whose admitting specialty was surgery, cardiothoracic surgery (57.3% and neurosurgery (29.7% were the two main types of surgery being performed. Pooled results showed that SOD had similar effects as SDD in day-28 mortality (RR =1

  14. Technology diffusion in hospitals: a log odds random effects regression model.

    Science.gov (United States)

    Blank, Jos L T; Valdmanis, Vivian G

    2015-01-01

    This study identifies the factors that affect the diffusion of hospital innovations. We apply a log odds random effects regression model on hospital micro data. We introduce the concept of clustering innovations and the application of a log odds random effects regression model to describe the diffusion of technologies. We distinguish a number of determinants, such as service, physician, and environmental, financial and organizational characteristics of the 60 Dutch hospitals in our sample. On the basis of this data set on Dutch general hospitals over the period 1995-2002, we conclude that there is a relation between a number of determinants and the diffusion of innovations underlining conclusions from earlier research. Positive effects were found on the basis of the size of the hospitals, competition and a hospital's commitment to innovation. It appears that if a policy is developed to further diffuse innovations, the external effects of demand and market competition need to be examined, which would de facto lead to an efficient use of technology. For the individual hospital, instituting an innovations office appears to be the most prudent course of action. © 2013 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.

  15. Hospital recruitment for a pragmatic cluster-randomized clinical trial: Lessons learned from the COMPASS study.

    Science.gov (United States)

    Johnson, Anna M; Jones, Sara B; Duncan, Pamela W; Bushnell, Cheryl D; Coleman, Sylvia W; Mettam, Laurie H; Kucharska-Newton, Anna M; Sissine, Mysha E; Rosamond, Wayne D

    2018-01-26

    Pragmatic randomized clinical trials are essential to determine the effectiveness of interventions in "real-world" clinical practice. These trials frequently use a cluster-randomized methodology, with randomization at the site level. Despite policymakers' increased interest in supporting pragmatic randomized clinical trials, no studies to date have reported on the unique recruitment challenges faced by cluster-randomized pragmatic trials. We investigated key challenges and successful strategies for hospital recruitment in the Comprehensive Post-Acute Stroke Services (COMPASS) study. The COMPASS study is designed to compare the effectiveness of the COMPASS model versus usual care in improving functional outcomes, reducing the numbers of hospital readmissions, and reducing caregiver strain for patients discharged home after stroke or transient ischemic attack. This model integrates early supported discharge planning with transitional care management, including nurse-led follow-up phone calls after 2, 30, and 60 days and an in-person clinic visit at 7-14 days involving a functional assessment and neurological examination. We present descriptive statistics of the characteristics of successfully recruited hospitals compared with all eligible hospitals, reasons for non-participation, and effective recruitment strategies. We successfully recruited 41 (43%) of 95 eligible North Carolina hospitals. Leading, non-exclusive reasons for non-participation included: insufficient staff or financial resources (n = 33, 61%), lack of health system support (n = 16, 30%), and lack of support of individual decision-makers (n = 11, 20%). Successful recruitment strategies included: building and nurturing relationships, engaging team members and community partners with a diverse skill mix, identifying gatekeepers, finding mutually beneficial solutions, having a central institutional review board, sharing published pilot data, and integrating contracts and review board

  16. Factors associated with induced abortion at selected hospitals in the Volta Region, Ghana

    Directory of Open Access Journals (Sweden)

    Klutsey EE

    2014-08-01

    Full Text Available Ellen Eyi Klutsey,1 Augustine Ankomah2 1School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta Region, 2Department of Population, Family and Reproductive Health School of Public Health, University of Ghana, Legon, Accra, Ghana Background: Induced abortion rates remained persistently high in the Volta Region of Ghana in the 5 years from 2006 to 2011. Some hospitals, both rural and urban, report induced abortion-related complications as one of the top ten conditions in hospital admissions. This study explored demographic and other factors associated with induced abortion, and also assessed awareness of abortion-related complications among women of reproductive age in the Volta Region. Methods: A quantitative, hospital-based, unmatched case-control study was performed. The Volta Region was stratified into two health administration zones, ie, north and south. For each zone, hospitals were stratified into government and private hospitals. Employing simple random sampling, one private and three government hospitals were selected from each zone. This study is therefore based on eight hospitals, ie, six government hospitals and two private hospitals. Results: Marital status, employment status, number of total pregnancies, and knowledge about contraception were found to be associated with induced abortion. Multiple logistic regression showed a 4% reduction in the odds of induced abortion in married women compared with women who were single (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.07–0.22. Unemployed women of reproductive age were found to be 0.35 times less likely to seek induced abortion compared with their employed counterparts (OR 0.35, CI 0.19–0.65. It was also observed that women with their second pregnancies were 3.8 times more likely to seek induced abortion and women with more than two pregnancies were 6.6 times more likely to do so (OR 3.81, CI 1.94–7.49 and OR 6.58, CI 2.58–16.79, respectively

  17. The biomedical waste management in selected hospitals of Chittoor ...

    African Journals Online (AJOL)

    Introduction: Poor waste management practices pose a huge risk to the health of the public, patients, professionals and contribute to environmental degradation. Aims and objectives: Our study was aimed to assess the present status of biomedical waste management in Government and Private Hospitals. Materials and ...

  18. Hospital site selection using fuzzy AHP and its derivatives.

    Science.gov (United States)

    Vahidnia, Mohammad H; Alesheikh, Ali A; Alimohammadi, Abbas

    2009-07-01

    Environmental managers are commonly faced with sophisticated decisions, such as choosing the location of a new facility subject to multiple conflicting criteria. This paper considers the specific problem of creating a well-distributed network of hospitals that delivers its services to the target population with minimal time, pollution and cost. We develop a Multi-Criteria Decision Analysis process that combines Geographical Information System (GIS) analysis with the Fuzzy Analytical Hierarchy Process (FAHP), and use this process to determine the optimum site for a new hospital in the Tehran urban area. The GIS was used to calculate and classify governing criteria, while FAHP was used to evaluate the decision factors and their impacts on alternative sites. Three methods were used to estimate the total weights and priorities of the candidate sites: fuzzy extent analysis, center-of-area defuzzification, and the alpha-cut method. The three methods yield identical priorities for the five alternatives considered. Fuzzy extent analysis provides less discriminating power, but is simpler to implement and compute than the other two methods. The alpha-cut method is more complicated, but integrates the uncertainty and overall attitude of the decision-maker. The usefulness of the new hospital site is evaluated by computing an accessibility index for each pixel in the GIS, defined as the ratio of population density to travel time. With the addition of a new hospital at the optimum site, this index improved over about 6.5 percent of the geographical area.

  19. Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial.

    Science.gov (United States)

    Levine, David M; Ouchi, Kei; Blanchfield, Bonnie; Diamond, Keren; Licurse, Adam; Pu, Charles T; Schnipper, Jeffrey L

    2018-02-06

    Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking. Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience. Randomized controlled trial. Adults admitted via the emergency department with any infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma. Home hospital care, including nurse and physician home visits, intravenous medications, continuous monitoring, video communication, and point-of-care testing. Primary outcome was direct cost of the acute care episode. Secondary outcomes included utilization, 30-day cost, physical activity, and patient experience. Nine patients were randomized to home, 11 to usual care. Median direct cost of the acute care episode for home patients was 52% (IQR, 28%; p = 0.05) lower than for control patients. During the care episode, home patients had fewer laboratory orders (median per admission: 6 vs. 19; p Home patients were more physically active (median minutes, 209 vs. 78; p home patients, one occurred in control patients. Median direct cost for the acute care plus 30-day post-discharge period for home patients was 67% (IQR, 77%; p home-care services (22% vs. 55%; p = 0.08) and fewer readmissions (11% vs. 36%; p = 0.32). Patient experience was similar in both groups. The use of substitutive home-hospitalization compared to in-hospital usual care reduced cost and utilization and improved physical activity. No significant differences in quality, safety, and patient experience were noted, with more definitive results awaiting a larger trial. Trial Registration NCT02864420.

  20. The relation between flexibility of human resources and performance indexes of selected hospitals of Tehran Medical Sciences University

    Directory of Open Access Journals (Sweden)

    Noushin Alibakhshi

    2016-12-01

    Full Text Available Today, flexibility has turned to one of important issues in management theories and policies and most current discussions about flexibility patterns focus on management policies, so that these patterns are one of important aspects of human resources strategic management. This study was performed with the aim of assessing the flexibility rate of human resources and performance indexes of Tehran Medical Sciences University hospitals and determining the possible relation between these variables. The present study is descriptive – analytical which was conducted in cross-sectional form in 2015. The statistical population was selected by stratifies random sampling method as 317 persons from nursing, administrative and financial personnel of 5 hospitals of Tehran Medical Sciences University. Data collecting toll was hospitals performance indexes form and Wright & Snell flexibility questionnaire of human resources. Data analysis was performed using SPSS 18 software and with the aid of descriptive statistical indexes and linear regression analysis. The results showed that personnel ( human resources had high flexibility = 4.16.\tthere was a significant relation between total flexibility and the index of bed circulation so that by one unit increase in bed circulation space, normally, the average of total flexibility decreased 0.64 units ( p-value<0.05. The results showed that human resources of Tehran Medical Sciences University hospitals have high flexibility, so authorities and policy makers are suggested to adopt policies of human resources management for creating flexibility in human resources and improving hospitals performance and amending hospitals status.

  1. Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan

    Science.gov (United States)

    Shukurova, Venera; Davletbaeva, Marina; Monolbaev, Kubanychbek; Kulichenko, Tatiana; Akoev, Yuri; Bakradze, Maya; Margieva, Tea; Mityushino, Ilya; Namazova-Baranova, Leyla; Boronbayeva, Elnura; Kuttumuratova, Aigul; Weber, Martin Willy; Tamburlini, Giorgio

    2017-01-01

    Abstract Objective To determine whether periodic supportive supervision after a training course improved the quality of paediatric hospital care in Kyrgyzstan, where inappropriate care was common but in-hospital postnatal mortality was low. Methods In a cluster, randomized, parallel-group trial, 10 public hospitals were allocated to a 4-day World Health Organization (WHO) course on hospital care for children followed by periodic supportive supervision by paediatricians for 1 year, while 10 hospitals had no intervention. We assessed prospectively 10 key indicators of inappropriate paediatric case management, as indicated by WHO guidelines. The primary indicator was the combination of the three indicators: unnecessary hospitalization, increased iatrogenic risk and unnecessary painful procedures. An independent team evaluated the overall quality of care. Findings We prospectively reviewed the medical records of 4626 hospitalized children aged 2 to 60 months. In the intervention hospitals, the mean proportion of the primary indicator decreased from 46.9% (95% confidence interval, CI: 24.2 to 68.9) at baseline to 6.8% (95% CI: 1.1 to 12.1) at 1 year, but was unchanged in the control group (45.5%, 95% CI: 25.2 to 67.9, to 64.7%, 95% CI: 43.3 to 86.1). At 1 year, the risk ratio for the primary indicator in the intervention versus the control group was 0.09 (95% CI: 0.06 to 0.13). The proportions of the other nine indicators also decreased in the intervention group (P < 0.0001 for all). Overall quality of care improved significantly in intervention hospitals. Conclusion Periodic supportive supervision for 1 year after a training course improved both adherence to WHO guidelines on hospital care for children and the overall quality of paediatric care. PMID:28603306

  2. X-ray film reject rate analysis at eight selected government hospitals ...

    African Journals Online (AJOL)

    admin

    Objective: The purpose of this research was to identify the main causes of film faults as well as the pattern and magnitude of film rejection. Methods: Using a prospective cross-sectional hospital based approach; eight public hospitals were selected in Addis. Ababa through .... clinical radiology service. In this respect, reject ...

  3. Zinc in selected hospital diets. Comparison of analysis vs. calculation.

    Science.gov (United States)

    Brown, E D; McGuckin, M A; Wilson, M; Smith, J C

    1976-12-01

    Sample hospital meals for breakfast and the noon and evening meals for regular, ovo-lacto-vegetarian, and renal diets were collected for seven consecutive days. The daily zinc content of each diet was determined, using atomic absorption spectrophotometric analysis and by calculation, using the USDA provisional tables on the zinc content of individual foods. The data indicated that the provisional tables provide a reasonable estimation of zinc content of regular or renal diets with errors approximately 10%. However, a 35% overestimation occurred for vegetarian diets. A major cause of error between assayed and calculated values was probably due to substituting items not included in the tables. The mean zinc content for the regular diet, as offered, was 97% of the adult recommended allowance for zinc, while the vegetarian diet provided 81% of the allowance. The average renal diet contained 49% of the allowance. Certain types of vegetarian and low-protein diets may be inadequate in total and/or available zinc. Also important in evaluating hospital diets for adequacy of zinc are the actual intake and the condition of the patient.

  4. Event selection with a Random Forest in IceCube

    Energy Technology Data Exchange (ETDEWEB)

    Ruhe, Tim [TU, Dortmund (Germany); Collaboration: IceCube-Collaboration

    2011-07-01

    The Random Forest method is a multivariate algorithm that can be used for classification and regression respectively. The Random Forest implemented in the RapidMiner learning environment has been used for training and validation on data and Monte Carlo simulations of the IceCube neutrino telescope. Latest results are presented.

  5. Study on MAX-MIN Ant System with Random Selection in Quadratic Assignment Problem

    Science.gov (United States)

    Iimura, Ichiro; Yoshida, Kenji; Ishibashi, Ken; Nakayama, Shigeru

    Ant Colony Optimization (ACO), which is a type of swarm intelligence inspired by ants' foraging behavior, has been studied extensively and its effectiveness has been shown by many researchers. The previous studies have reported that MAX-MIN Ant System (MMAS) is one of effective ACO algorithms. The MMAS maintains the balance of intensification and diversification concerning pheromone by limiting the quantity of pheromone to the range of minimum and maximum values. In this paper, we propose MAX-MIN Ant System with Random Selection (MMASRS) for improving the search performance even further. The MMASRS is a new ACO algorithm that is MMAS into which random selection was newly introduced. The random selection is one of the edgechoosing methods by agents (ants). In our experimental evaluation using ten quadratic assignment problems, we have proved that the proposed MMASRS with the random selection is superior to the conventional MMAS without the random selection in the viewpoint of the search performance.

  6. Occupational Therapy Predischarge Home Visits in Acute Hospital Care: A Randomized Trial.

    Science.gov (United States)

    Clemson, Lindy; Lannin, Natasha A; Wales, Kylie; Salkeld, Glenn; Rubenstein, Laurence; Gitlin, Laura; Barris, Sarah; Mackenzie, Lynette; Cameron, Ian D

    2016-10-01

    To determine whether an enhanced occupational therapy discharge planning intervention that involved pre- and postdischarge home visits, goal setting, and follow-up (the HOME program) would be superior to a usual care intervention in which an occupational therapy in-hospital consultation for planning and supporting discharge to home is provided to individuals receiving acute care. Randomized controlled trial. Acute and medical wards. Individuals aged 70 and older (N = 400). Primary outcomes: activities daily living (ADLs; Nottingham Extended Activities of Daily Living) and participation in life roles and activities (Late Life Disability Index (LLDI)). Occupational therapist recommendations differed significantly between groups (P occupational therapy recommendations as the in-hospital only consultation, which had a greater emphasis on equipment provision, but HOME did not demonstrate greater benefit in global measures of ADLs or participation in life tasks than in-hospital consultation alone. It is not recommended that home visits be conducted routinely as part of discharge planning for acutely hospitalized medical patients. Further work should develop guidelines for quality in-hospital consultation. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  7. The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities.

    Science.gov (United States)

    Connolly, Martin J; Boyd, Michal; Broad, Joanna B; Kerse, Ngaire; Lumley, Thomas; Whitehead, Noeline; Foster, Susan

    2015-01-01

    To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. Cluster randomized controlled trial. RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. A total of 1998 residents of 18 intervention facilities and 18 control facilities. A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85-1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76-1.61; P = .62). This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943). Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  8. The perception of hospital safety culture and selected outcomes among nurses: An exploratory study.

    Science.gov (United States)

    Saleh, Ali M; Darawad, Muhammad W; Al-Hussami, Mahmoud

    2015-09-01

    The objectives of this study were to examine nurses' perceptions of the hospital safety culture in Jordan and to identify the relationships between aspects of hospital safety culture and selected safety outcomes. Data from 242 registered nurses in five Jordanian hospitals were analyzed. Aspects of hospital safety culture and outcomes were measured using the Hospital Survey on Patient Safety Culture. Among various aspects of hospital safety culture, teamwork within units had the highest average percentage of positive responses (49.8%). Additionally, participants reported deficits in other aspects of safety culture, particularly in staffing and nonpunitive response to errors, with average percentages of positive responses of 30.4% and 30.7%, respectively. Pearson correlation analysis revealed that 9 of 10 subscales of hospital safety culture were significantly correlated to one or more of the hospital safety outcomes. The findings of this study can help policymakers and healthcare administrators identify the weaknesses and strengths of hospital safety issues in order to propose effective strategies to improve patient safety and quality of care. © 2015 Wiley Publishing Asia Pty Ltd.

  9. Nutritional Follow-Up after Discharge Prevents Readmission to Hospital - A Randomized Clinical Trial.

    Science.gov (United States)

    Lindegaard Pedersen, J; Pedersen, P U; Damsgaard, E M

    2017-01-01

    To compare the effects of two individualized nutritional follow-up intervention strategies (home visit or telephone consultation) with no follow-up, with regard to acute readmissions to hospital at two points in time, 30 and 90 days after discharge from hospital. Randomized clinical trial with two intervention groups and one control group, and monitoring on readmission at 30 and 90 days after discharge. Intervention in the participants' homes after discharge from hospital. Inclusion: Malnourished geriatric patients and patients at risk of malnutrition (MNAdischarge, the patients were stratified according to nutritional status (MNA), and assigned to one of three groups: 'home visit', 'telephone', or 'control' group. Individualized nutritional counselling of the patient and the patient's daily home carer by a clinical dietician one, two, and four weeks after discharge from hospital. The counselling was either in-person at the patient's homes, or over the telephone. All patients received a diet plan on discharge. The control group received standard care, but no follow-up after discharge. Information on readmissions to hospital and mortality at 30 and 90 days after discharge was obtained from electronic patient records. Intention-to-treat (ITT) and per-protocol (PP) analyses were carried out. Two-hundred and eight participants were randomized, 73 to home visits, 68 to the telephone consultation group, and 67 to the control group. The mean age of the participants was 86.1 years. Home visit participants had a lower risk of readmission to hospital compared to control participants at 30 days after discharge (HR=0.4; 95% CI: 0.2-0.9, p=0.03) and 90 days after discharge (HR=0.4; 95% CI: 0.2-0.8, pdischarge (HR=0.7, 95% CI: 0.4-1.3, p=0.23). The PP analysis revealed that the risk of readmission was significantly lower in the home visit group compared to the control group and the telephone consultation group compared to the control group, and this was evident at 30 days as

  10. A Randomized Controlled Trial of Hospital-based Case Management in Cancer Care

    DEFF Research Database (Denmark)

    Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens

    2012-01-01

    -based CM on (i) GPs' evaluation of information from the hospital and collaboration with the hospital staff and (ii) patients' contacts with GPs during daytime and out of hours. DESIGN: A randomized controlled trial allocated 280 colorectal cancer patients 1:1 to either a control group or CM intervention....... SETTING: Patients were recruited at a Danish surgical department. METHODS: An ad hoc piloted questionnaire was sent to all patients' GPs 30 weeks after patients' recruitment and the responses from the two groups of GPs were compared. Registry data on patients' contacts with general practice during daytime...... and out of hours were collected 9 months after recruitment and the data from the two groups were compared quarterly. RESULTS: CM was associated with an overall tendency towards more positive GP evaluations, which for 3 of 20 items reached statistical significance. Statistically significantly fewer GPs...

  11. Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY: a pilot cluster randomized trial

    Directory of Open Access Journals (Sweden)

    Pai Menaka

    2013-01-01

    Full Text Available Abstract Background Venous thromboembolism (VTE is a common preventable cause of mortality in hospitalized medical patients. Despite rigorous randomized trials generating strong recommendations for anticoagulant use to prevent VTE, nearly 40% of medical patients receive inappropriate thromboprophylaxis. Knowledge-translation strategies are needed to bridge this gap. Methods We conducted a 16-week pilot cluster randomized controlled trial (RCT to determine the proportion of medical patients that were appropriately managed for thromboprophylaxis (according to the American College of Chest Physician guidelines within 24 hours of admission, through the use of a multicomponent knowledge-translation intervention. Our primary goal was to determine the feasibility of conducting this study on a larger scale. The intervention comprised clinician education, a paper-based VTE risk assessment algorithm, printed physicians’ orders, and audit and feedback sessions. Medical wards at six hospitals (representing clusters in Ontario, Canada were included; three were randomized to the multicomponent intervention and three to usual care (i.e., no active strategies for thromboprophylaxis in place. Blinding was not used. Results A total of 2,611 patients (1,154 in the intervention and 1,457 in the control group were eligible and included in the analysis. This multicomponent intervention did not lead to a significant difference in appropriate VTE prophylaxis rates between intervention and control hospitals (appropriate management rate odds ratio = 0.80; 95% confidence interval: 0.50, 1.28; p = 0.36; intra-class correlation coefficient: 0.022, and thus was not considered feasible. Major barriers to effective knowledge translation were poor attendance by clinical staff at education and feedback sessions, difficulty locating preprinted orders, and lack of involvement by clinical and administrative leaders. We identified several factors that may increase uptake of a VTE

  12. Using ArcMap, Google Earth, and Global Positioning Systems to select and locate random households in rural Haiti

    Directory of Open Access Journals (Sweden)

    Wampler Peter J

    2013-01-01

    Full Text Available Abstract Background A remote sensing technique was developed which combines a Geographic Information System (GIS; Google Earth, and Microsoft Excel to identify home locations for a random sample of households in rural Haiti. The method was used to select homes for ethnographic and water quality research in a region of rural Haiti located within 9 km of a local hospital and source of health education in Deschapelles, Haiti. The technique does not require access to governmental records or ground based surveys to collect household location data and can be performed in a rapid, cost-effective manner. Methods The random selection of households and the location of these households during field surveys were accomplished using GIS, Google Earth, Microsoft Excel, and handheld Garmin GPSmap 76CSx GPS units. Homes were identified and mapped in Google Earth, exported to ArcMap 10.0, and a random list of homes was generated using Microsoft Excel which was then loaded onto handheld GPS units for field location. The development and use of a remote sensing method was essential to the selection and location of random households. Results A total of 537 homes initially were mapped and a randomized subset of 96 was identified as potential survey locations. Over 96% of the homes mapped using Google Earth imagery were correctly identified as occupied dwellings. Only 3.6% of the occupants of mapped homes visited declined to be interviewed. 16.4% of the homes visited were not occupied at the time of the visit due to work away from the home or market days. A total of 55 households were located using this method during the 10 days of fieldwork in May and June of 2012. Conclusions The method used to generate and field locate random homes for surveys and water sampling was an effective means of selecting random households in a rural environment lacking geolocation infrastructure. The success rate for locating households using a handheld GPS was excellent and only

  13. Using ArcMap, Google Earth, and Global Positioning Systems to select and locate random households in rural Haiti.

    Science.gov (United States)

    Wampler, Peter J; Rediske, Richard R; Molla, Azizur R

    2013-01-18

    A remote sensing technique was developed which combines a Geographic Information System (GIS); Google Earth, and Microsoft Excel to identify home locations for a random sample of households in rural Haiti. The method was used to select homes for ethnographic and water quality research in a region of rural Haiti located within 9 km of a local hospital and source of health education in Deschapelles, Haiti. The technique does not require access to governmental records or ground based surveys to collect household location data and can be performed in a rapid, cost-effective manner. The random selection of households and the location of these households during field surveys were accomplished using GIS, Google Earth, Microsoft Excel, and handheld Garmin GPSmap 76CSx GPS units. Homes were identified and mapped in Google Earth, exported to ArcMap 10.0, and a random list of homes was generated using Microsoft Excel which was then loaded onto handheld GPS units for field location. The development and use of a remote sensing method was essential to the selection and location of random households. A total of 537 homes initially were mapped and a randomized subset of 96 was identified as potential survey locations. Over 96% of the homes mapped using Google Earth imagery were correctly identified as occupied dwellings. Only 3.6% of the occupants of mapped homes visited declined to be interviewed. 16.4% of the homes visited were not occupied at the time of the visit due to work away from the home or market days. A total of 55 households were located using this method during the 10 days of fieldwork in May and June of 2012. The method used to generate and field locate random homes for surveys and water sampling was an effective means of selecting random households in a rural environment lacking geolocation infrastructure. The success rate for locating households using a handheld GPS was excellent and only rarely was local knowledge required to identify and locate households. This

  14. In vivo selection of randomly mutated retroviral genomes

    NARCIS (Netherlands)

    Berkhout, B.; Klaver, B.

    1993-01-01

    Darwinian evolution, that is the outgrowth of the fittest variants in a population, usually applies to living organisms over long periods of time. Recently, in vitro selection/amplification techniques have been developed that allow for the rapid evolution of functionally active nucleic acids from a

  15. Assessing the accuracy and stability of variable selection methods for random forest modeling in ecology

    Science.gov (United States)

    Random forest (RF) modeling has emerged as an important statistical learning method in ecology due to its exceptional predictive performance. However, for large and complex ecological datasets there is limited guidance on variable selection methods for RF modeling. Typically, e...

  16. The frequency of drugs in randomly selected drivers in Denmark

    DEFF Research Database (Denmark)

    Simonsen, Kirsten Wiese; Steentoft, Anni; Hels, Tove

    Introduction Driving under the influence of alcohol and drugs is a global problem. In Denmark as well as in other countries there is an increasing focus on impaired driving. Little is known about the occurrence of psychoactive drugs in the general traffic. Therefore the European commission...... initiated the DRUID project. This roadside study is the Danish part of the EU-project DRUID (Driving under the Influence of Drugs, Alcohol, and Medicines) and included three representative regions in Denmark. Methods Oral fluid samples (n = 3002) were collected randomly from drivers using a sampling scheme...... stratified by time, season, and road type. The oral fluid samples were screened for 29 illegal and legal psychoactive substances and metabolites as well as ethanol. Results Fourteen (0.5%) drivers were positive for ethanol (alone or in combination with drugs) at concentrations above 0.53 g/l, which...

  17. Sample Selection in Randomized Experiments: A New Method Using Propensity Score Stratified Sampling

    Science.gov (United States)

    Tipton, Elizabeth; Hedges, Larry; Vaden-Kiernan, Michael; Borman, Geoffrey; Sullivan, Kate; Caverly, Sarah

    2014-01-01

    Randomized experiments are often seen as the "gold standard" for causal research. Despite the fact that experiments use random assignment to treatment conditions, units are seldom selected into the experiment using probability sampling. Very little research on experimental design has focused on how to make generalizations to well-defined…

  18. Pseudo cluster randomization dealt with selection bias and contamination in clinical trials

    NARCIS (Netherlands)

    Teerenstra, S.; Melis, R.J.F.; Peer, P.G.M.; Borm, G.F.

    2006-01-01

    BACKGROUND AND OBJECTIVES: When contamination is present, randomization on a patient level leads to dilution of the treatment effect. The usual solution is to randomize on a cluster level, but at the cost of efficiency and more importantly, this may introduce selection bias. Furthermore, it may slow

  19. Hospital admissions and school dropout: a retrospective cohort study of the 'selection hypothesis'.

    Science.gov (United States)

    van Heesch, Mirjam M J; Bosma, Hans; Traag, Tanja; Otten, Ferdy

    2012-08-01

    School dropout is an important predictor of poor health and of high relevance for public health (in accord with the 'causation hypothesis'). Rather than examining how dropout affects health, we set out to examine how poor health might affect school dropout (in accord with the 'selection hypothesis'). Hospital admissions are potentially indicative of more serious disease and might be expected to result in learning backlogs. Longitudinal data of the Dutch Secondary Education Pupil Cohort 1993 (VOCL'93) and the National Medical Registration (LMR) were combined. The study population consisted of 16,239 pupils who were followed from first grade at secondary school until they left fulltime education. Pupils were monitored regarding both their educational careers and their hospital admissions. Nine percent had a hospital admission and 10% became a school dropout. Hospital admissions were only predictive of later school dropout for pupils starting in the highest type of secondary education (pre-university education) [OR 1.54 (95% CI 1.05-2.26)], not for pupils with lower educational levels. Pre-university pupils who had been hospitalized for more than 9 days [OR 2.34 (95% CI 1.08-5.09)] or who were hospitalized more than three times [OR 4.20 (95% CI 1.75-10.04)] had particularly heightened odds of school dropout. Our findings further support the 'selection hypothesis' and confirm the relevance of dropout for public health. Public health workers and educational professionals should probably aim at intensified monitoring of children who have been hospitalized and simultaneously aim at improving accessibility to (higher quality) education in the hospital.

  20. Efficacy of Sleep Tool Education During Hospitalization: A Randomized Controlled Trial.

    Science.gov (United States)

    Farrehi, Peter M; Clore, Kristen R; Scott, J Ryan; Vanini, Giancarlo; Clauw, Daniel J

    2016-12-01

    Patients are commonly provided tools in the hospital to overcome poor sleep. Whether education on use of sleep tools can impact health outcomes from a patient perspective is not known. We recruited 120 adults admitted to a nonintensive care unit cardiac-monitored floor. All patients received a set of sleep-enhancing tools (eye mask, ear plugs, and a white noise machine) and were randomized to receive direct education on use of and benefit of these sleep-enhancing tools (intervention), or an equal amount of time was spent discussing general benefits of sleep (control). Measurement of several symptom domains was assessed daily by health outcome survey responses, and change from baseline was assessed for differences between groups. Inpatient opioid use and length of stay were also measured. Participants randomized to receive the education intervention had a significantly greater decrease in fatigue scores over the 3 days, compared with controls (5.30 ± 6.93 vs 1.81 ± 6.96, t = 2.32, P = .028). There was a trend toward improvements in multiple other sleep-related domains, including sleep disturbance, sleep-related impairment, physical functioning, pain severity, or pain interference (all P >.140). There was no difference in length of stay between intervention and control groups (7.40 ± 7.29 vs 7.71 ± 6.06 days, P = .996). The change in number of opioid equivalents taken did not differ use between the groups (P = .688). In a randomized trial of education in the use of sleep-enhancing tools while hospitalized, patient fatigue was significantly improved, whereas several other patient-reported outcomes showed a trend toward improvements. Implementation of this very low-cost approach to improving sleep and well-being could substantially improve the patient care experience. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Acceptance sampling using judgmental and randomly selected samples

    Energy Technology Data Exchange (ETDEWEB)

    Sego, Landon H.; Shulman, Stanley A.; Anderson, Kevin K.; Wilson, John E.; Pulsipher, Brent A.; Sieber, W. Karl

    2010-09-01

    We present a Bayesian model for acceptance sampling where the population consists of two groups, each with different levels of risk of containing unacceptable items. Expert opinion, or judgment, may be required to distinguish between the high and low-risk groups. Hence, high-risk items are likely to be identifed (and sampled) using expert judgment, while the remaining low-risk items are sampled randomly. We focus on the situation where all observed samples must be acceptable. Consequently, the objective of the statistical inference is to quantify the probability that a large percentage of the unsampled items in the population are also acceptable. We demonstrate that traditional (frequentist) acceptance sampling and simpler Bayesian formulations of the problem are essentially special cases of the proposed model. We explore the properties of the model in detail, and discuss the conditions necessary to ensure that required samples sizes are non-decreasing function of the population size. The method is applicable to a variety of acceptance sampling problems, and, in particular, to environmental sampling where the objective is to demonstrate the safety of reoccupying a remediated facility that has been contaminated with a lethal agent.

  2. Impact of Nutritional Intervention on Length of Hospital Stay and Mortality among Hospitalized Patients with Malnutrition: A Clinical Randomized Controlled Trial.

    Science.gov (United States)

    Cano-Torres, Edgar A; Simental-Mendía, Luis E; Morales-Garza, Luis A; Ramos-Delgado, José M; Reyes-Gonzalez, Mirthala M; Sánchez-Nava, Victor M; Barragán-Berlanga, Abel de J; Rangel-Rodríguez, Ignacio; Guerrero-Romero, Fernando

    2017-01-01

    The objective of this study was to evaluate the impact of a nutritional intervention on hospital stay and mortality among hospitalized patients with malnutrition. Hospitalized patients with a diagnosis of malnutrition were enrolled and randomly allocated to either an intervention or control group. Participants in the intervention group received an individualized nutrition plan according to energy and protein (1.0-1.5 g/kg) intake requirements as well as dietary advice based on face-to-face interviews with patients and their caregivers or family members. Individuals in the control group received standard nutritional management according to the Hospital Nutrition Department. Nutritional status and disease severity were assessed using nutritional risk screening. Length of hospital stay was defined by the number of days of hospitalization from hospital admission to medical discharge. Reference to another service or death were criteria for study withdrawal. To evaluate mortality, individuals were followed up for 6 months after hospital discharge. Hospital stay and mortality were the intention-to-treat analysis. A total of 55 patients with an average age of 57.1 ± 20.7 years were included into intervention (n = 28) and control (n = 27) groups, respectively. At basal condition, nutritional status, measured by nutritional risk screening score, was similar between the study groups (4.1 ± 0.8 vs 4.2 ± 1.2, p = 0.6). The average hospital stay was lower in the intervention group compared to the control group (6.4 ± 3.0 vs 8.4 ± 4.0 days, p = 0.03). Finally, the mortality rate at 6 months of follow-up was similar in both groups (hazard ratio [HR] = 0.85; 95% confidence interval [CI], 0.17-4.21). Results of this study suggest that, in hospitalized patients with malnutrition, nutritional intervention and dietary advice decrease hospital stay but not mortality.

  3. Hypnosis can reduce pain in hospitalized older patients: a randomized controlled study.

    Science.gov (United States)

    Ardigo, Sheila; Herrmann, François R; Moret, Véronique; Déramé, Laurence; Giannelli, Sandra; Gold, Gabriel; Pautex, Sophie

    2016-01-15

    Chronic pain is a common and serious health problem in older patients. Treatment often includes non pharmacological approaches despite a relatively modest evidence base in this population. Hypnosis has been used in younger adults with positive results. The main objective of this study was to measure the feasibility and efficacy of hypnosis (including self hypnosis) in the management of chronic pain in older hospitalized patients. A single center randomized controlled trial using a two arm parallel group design (hypnosis versus massage). Inclusion criteria were chronic pain for more than 3 months with impact on daily life activities, intensity of > 4; adapted analgesic treatment; no cognitive impairment. Brief pain inventory was completed. Fifty-three patients were included (mean age: 80.6 ± 8.2--14 men; 26 hypnosis; 27 massage. Pain intensity decreased significantly in both groups after each session. Average pain measured by the brief pain index sustained a greater decrease in the hypnosis group compared to the massage group during the hospitalisation. This was confirmed by the measure of intensity of the pain before each session that decreased only in the hypnosis group over time (P = 0.008). Depression scores improved significantly over the time only in the hypnosis group (P = 0.049). There was no effect in either group 3 months post hospitals discharge. Hypnosis represents a safe and valuable tool in chronic pain management of hospitalized older patients. In hospital interventions did not provide long term post discharge relief. ISRCTN15615614; registered 2/1/2015.

  4. RANDOM FORESTS-BASED FEATURE SELECTION FOR LAND-USE CLASSIFICATION USING LIDAR DATA AND ORTHOIMAGERY

    Directory of Open Access Journals (Sweden)

    H. Guan

    2012-07-01

    Full Text Available The development of lidar system, especially incorporated with high-resolution camera components, has shown great potential for urban classification. However, how to automatically select the best features for land-use classification is challenging. Random Forests, a newly developed machine learning algorithm, is receiving considerable attention in the field of image classification and pattern recognition. Especially, it can provide the measure of variable importance. Thus, in this study the performance of the Random Forests-based feature selection for urban areas was explored. First, we extract features from lidar data, including height-based, intensity-based GLCM measures; other spectral features can be obtained from imagery, such as Red, Blue and Green three bands, and GLCM-based measures. Finally, Random Forests is used to automatically select the optimal and uncorrelated features for landuse classification. 0.5-meter resolution lidar data and aerial imagery are used to assess the feature selection performance of Random Forests in the study area located in Mannheim, Germany. The results clearly demonstrate that the use of Random Forests-based feature selection can improve the classification performance by the selected features.

  5. Developing a management information system for a hospital: a case study on vendor selection.

    Science.gov (United States)

    Tsay, B Y; Stackhouse, J R

    1991-12-01

    This study examines the decision-making process that a medium-sized hospital took to develop a management information system. Since system developers in this particular hospital were all users without system expertise, a substantial amount of time was devoted to their search for relevant information. Outside consulting, literature review, and a market survey were conducted for the developers to understand the characteristics of systems products on the market. Developers also invited extended user participation in vendor evaluation. The authors analyzed the reasoning process behind the successful selection of a vendor-supported information system. The findings provide hospitals of similar characteristics a decision model to follow in their search for a vendor-supported information system.

  6. Effect of lullaby and classical music on physiologic stability of hospitalized preterm infants: a randomized trial.

    Science.gov (United States)

    Amini, E; Rafiei, P; Zarei, K; Gohari, M; Hamidi, M

    2013-01-01

    Music is considered a subset of developmental supportive care. It may act as a suitable auditory stimulant in preterm infants. Also, it may reduce stress responses in autonomic, motor and state systems. To assess and compare the influence of lullaby and classical music on physiologic parameters. This is a randomized clinical trial with cross-over design. A total of 25 stable preterm infants with birth weight of 1000-2500 grams were studied for six consecutive days. Each infant was exposed to three phases: lullaby music, classical music, and no music (control) for two days each. The sequence of these phases was assigned randomly to each subject. Babies were continuously monitored for heart rate, respiratory rate, and oxygen saturation and changes between phases were analyzed. Lullaby reduced heart rate (p music reduced heart rate (p = 0.018). The effects of classical music disappeared once the music stopped. Oxygen saturation did not change during intervention. Music can affect vital signs of preterm infants; this effect can possibly be related to the reduction of stress during hospitalization. The implications of these findings on clinical and developmental outcomes need further study.

  7. Hospitals

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...

  8. A randomized controlled trial of isotonic versus hypotonic maintenance intravenous fluids in hospitalized children.

    Science.gov (United States)

    Saba, Thomas G; Fairbairn, James; Houghton, Fiona; Laforte, Diane; Foster, Bethany J

    2011-09-23

    Isotonic saline has been proposed as a safer alternative to traditional hypotonic solutions for intravenous (IV) maintenance fluids to prevent hyponatremia. However, the optimal tonicity of maintenance intravenous fluids in hospitalized children has not been determined. The objective of this study was to estimate and compare the rates of change in serum sodium ([Na]) for patients administered either hypotonic or isotonic IV fluids for maintenance needs. This was a masked controlled trial. Randomization was stratified by admission type: medical patients and post-operative surgical patients, aged 3 months to 18 years, who required IV fluids for at least 8 hours. Patients were randomized to receive either 0.45% or 0.9% saline in 5.0% dextrose. Treating physicians used the study fluid for maintenance; infusion rate and the use of additional fluids were left to their discretion. Sixteen children were randomized to 0.9% saline and 21 to 0.45% saline. Baseline characteristics, duration (average of 12 hours) and rate of study fluid infusion, and the volume of additional isotonic fluids given were similar for the two groups. [Na] increased significantly in the 0.9% group (+0.20 mmol/L/h [IQR +0.03, +0.4]; P = 0.02) and increased, but not significantly, in the 0.45% group (+0.08 mmol/L/h [IQR -0.15, +0.16]; P = 0.07). The rate of change and absolute change in serum [Na] did not differ significantly between groups. When administered at the appropriate maintenance rate and accompanied by adequate volume expansion with isotonic fluids, 0.45% saline did not result in a drop in serum sodium during the first 12 hours of fluid therapy in children without severe baseline hyponatremia. Confirmation in a larger study is strongly recommended. NCT00457873 (http://www.clinicaltrials.gov/).

  9. A randomized controlled trial of isotonic versus hypotonic maintenance intravenous fluids in hospitalized children

    Directory of Open Access Journals (Sweden)

    Laforte Diane

    2011-09-01

    Full Text Available Abstract Background Isotonic saline has been proposed as a safer alternative to traditional hypotonic solutions for intravenous (IV maintenance fluids to prevent hyponatremia. However, the optimal tonicity of maintenance intravenous fluids in hospitalized children has not been determined. The objective of this study was to estimate and compare the rates of change in serum sodium ([Na] for patients administered either hypotonic or isotonic IV fluids for maintenance needs. Methods This was a masked controlled trial. Randomization was stratified by admission type: medical patients and post-operative surgical patients, aged 3 months to 18 years, who required IV fluids for at least 8 hours. Patients were randomized to receive either 0.45% or 0.9% saline in 5.0% dextrose. Treating physicians used the study fluid for maintenance; infusion rate and the use of additional fluids were left to their discretion. Results Sixteen children were randomized to 0.9% saline and 21 to 0.45% saline. Baseline characteristics, duration (average of 12 hours and rate of study fluid infusion, and the volume of additional isotonic fluids given were similar for the two groups. [Na] increased significantly in the 0.9% group (+0.20 mmol/L/h [IQR +0.03, +0.4]; P = 0.02 and increased, but not significantly, in the 0.45% group (+0.08 mmol/L/h [IQR -0.15, +0.16]; P = 0.07. The rate of change and absolute change in serum [Na] did not differ significantly between groups. Conclusions When administered at the appropriate maintenance rate and accompanied by adequate volume expansion with isotonic fluids, 0.45% saline did not result in a drop in serum sodium during the first 12 hours of fluid therapy in children without severe baseline hyponatremia. Confirmation in a larger study is strongly recommended. Clinical Trial Registration Number NCT00457873 (http://www.clinicaltrials.gov/

  10. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial.

    Science.gov (United States)

    Deutz, Nicolaas E; Matheson, Eric M; Matarese, Laura E; Luo, Menghua; Baggs, Geraldine E; Nelson, Jeffrey L; Hegazi, Refaat A; Tappenden, Kelly A; Ziegler, Thomas R

    2016-02-01

    Hospitalized, malnourished older adults have a high risk of readmission and mortality. Evaluation of a high-protein oral nutritional supplement (HP-HMB) containing beta-hydroxy-beta-methylbutyrate on postdischarge outcomes of nonelective readmission and mortality in malnourished, hospitalized older adults. Multicenter, randomized, placebo-controlled, double-blind trial. Inpatient and posthospital discharge. Older (≥65 years), malnourished (Subjective Global Assessment [SGA] class B or C) adults hospitalized for congestive heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease. Standard-of-care plus HP-HMB (n = 328) or a placebo supplement (n = 324), 2 servings/day. Primary composite endpoint was 90-day postdischarge incidence of death or nonelective readmission. Other endpoints included 30- and 60-day postdischarge incidence of death or readmission, length of stay (LOS), SGA class, body weight, and activities of daily living (ADL). The primary composite endpoint was similar between HP-HMB (26.8%) and placebo (31.1%). No between-group differences were observed for 90-day readmission rate, but 90-day mortality was significantly lower with HP-HMB relative to placebo (4.8% vs. 9.7%; relative risk 0.49, 95% confidence interval [CI], 0.27 to 0.90; p = 0.018). The number-needed-to-treat to prevent 1 death was 20.3 (95% CI: 10.9, 121.4). Compared with placebo, HP-HMB resulted in improved odds of better nutritional status (SGA class, OR, 2.04, 95% CI: 1.28, 3.25, p = 0.009) at day 90, and an increase in body weight at day 30 (p = 0.035). LOS and ADL were similar between treatments. Limited generalizability; patients represent a selected hospitalized population. Although no effects were observed for the primary composite endpoint, compared with placebo HP-HMB decreased mortality and improved indices of nutritional status during the 90-day observation period. www.ClinicalTrials.govNCT01626742. Copyright © 2015 The Authors. Published

  11. A Review on influencing criteria for selecting supplier of information technology services in the hospital.

    Science.gov (United States)

    Ajami, Sima; Rajabzadeh, Ahmad; Ketabi, Saeedeh

    2014-01-01

    Organizations try to outsource their activities as much as possible in order to prevent the problems and use organizational capabilities in Information Technology (IT) field. The purpose of this paper was first, to express the effective criteria for selecting suppliers of IT services, second, to explain the advantages and disadvantages of outsourcing IT in hospitals. This study was narrative review, which search was conducted with the help of libraries, books, conference proceedings, and databases of Science Direct, PubMed, Proquest, Springer, and SID (Scientific Information Database). In our searches, we employed the following keywords and their combinations: Outsourcing, information technology, hospital, decision making, and criteria. The preliminary search resulted in 120 articles, which were published between 2000 and 2013 during July 2013. After a careful analysis of the content of each paper, a total of 46 papers were selected based on their relevancy. The criteria and sub-criteria influencing outsourcing decisions in Iranian hospitals were identified in six major categories including administrative issues, issues related to the service/product, technology factors, environmental factors, risks, and economic factors associated with 15 sub-criteria containing business integration, dependence on suppliers, human resources, focus on core competencies, facilities and physical capital, innovation, quality, speed of service delivery, flexibility, market capabilities, geographical location, security, management control, cost, and financial capability. Identify the advantages and disadvantages of outsourcing and effective criteria in IT services supplier selection causes the managers be able to take the most appropriate decision to select supplier of IT services. This is a general review on influencing criteria for electing of supplier of information technology services in hospitals.

  12. SNP selection and classification of genome-wide SNP data using stratified sampling random forests.

    Science.gov (United States)

    Wu, Qingyao; Ye, Yunming; Liu, Yang; Ng, Michael K

    2012-09-01

    For high dimensional genome-wide association (GWA) case-control data of complex disease, there are usually a large portion of single-nucleotide polymorphisms (SNPs) that are irrelevant with the disease. A simple random sampling method in random forest using default mtry parameter to choose feature subspace, will select too many subspaces without informative SNPs. Exhaustive searching an optimal mtry is often required in order to include useful and relevant SNPs and get rid of vast of non-informative SNPs. However, it is too time-consuming and not favorable in GWA for high-dimensional data. The main aim of this paper is to propose a stratified sampling method for feature subspace selection to generate decision trees in a random forest for GWA high-dimensional data. Our idea is to design an equal-width discretization scheme for informativeness to divide SNPs into multiple groups. In feature subspace selection, we randomly select the same number of SNPs from each group and combine them to form a subspace to generate a decision tree. The advantage of this stratified sampling procedure can make sure each subspace contains enough useful SNPs, but can avoid a very high computational cost of exhaustive search of an optimal mtry, and maintain the randomness of a random forest. We employ two genome-wide SNP data sets (Parkinson case-control data comprised of 408 803 SNPs and Alzheimer case-control data comprised of 380 157 SNPs) to demonstrate that the proposed stratified sampling method is effective, and it can generate better random forest with higher accuracy and lower error bound than those by Breiman's random forest generation method. For Parkinson data, we also show some interesting genes identified by the method, which may be associated with neurological disorders for further biological investigations.

  13. An efficient method of wavelength interval selection based on random frog for multivariate spectral calibration

    Science.gov (United States)

    Yun, Yong-Huan; Li, Hong-Dong; Wood, Leslie R. E.; Fan, Wei; Wang, Jia-Jun; Cao, Dong-Sheng; Xu, Qing-Song; Liang, Yi-Zeng

    2013-07-01

    Wavelength selection is a critical step for producing better prediction performance when applied to spectral data. Considering the fact that the vibrational and rotational spectra have continuous features of spectral bands, we propose a novel method of wavelength interval selection based on random frog, called interval random frog (iRF). To obtain all the possible continuous intervals, spectra are first divided into intervals by moving window of a fix width over the whole spectra. These overlapping intervals are ranked applying random frog coupled with PLS and the optimal ones are chosen. This method has been applied to two near-infrared spectral datasets displaying higher efficiency in wavelength interval selection than others. The source code of iRF can be freely downloaded for academy research at the website: http://code.google.com/p/multivariate-calibration/downloads/list.

  14. Comparative Effectiveness of Post-Discharge Strategies for Hospitalized Smokers: study protocol for the Helping HAND 2 randomized controlled trial.

    Science.gov (United States)

    Reid, Zachary Z; Regan, Susan; Kelley, Jennifer H K; Streck, Joanna M; Ylioja, Thomas; Tindle, Hilary A; Chang, Yuchiao; Levy, Douglas E; Park, Elyse R; Singer, Daniel E; Carpenter, Kelly M; Reyen, Michele; Rigotti, Nancy A

    2015-02-07

    Smoking cessation interventions for hospitalized smokers are effective in promoting smoking cessation, but only if the tobacco dependence treatment continues after the patient leaves the hospital. Sustaining tobacco dependence treatment after hospital discharge is a challenge for health care systems. Our previous single-site randomized controlled trial demonstrated the effectiveness of an intervention that facilitated the delivery of comprehensive tobacco cessation treatment, including both medication and counseling, after hospital discharge. We subsequently streamlined the intervention model to increase its potential for dissemination. This new model is being tested in a larger multi-site trial with broader eligibility criteria in order to enroll a more representative sample of hospitalized smokers. This paper describes the trial design and contrasts it with the earlier study. A 2-arm, 3-site randomized controlled trial is testing the hypothesis that a multi-component Sustained Care intervention is more effective than Standard Care in helping hospitalized cigarette smokers stop smoking after hospital discharge. The trial enrolls adult daily cigarette smokers who are admitted to 1 of 3 participating hospitals in Massachusetts or Pennsylvania. Participants receive the same smoking cessation intervention in the hospital. They are randomly assigned to receive either Standard Care or Sustained Care after hospital discharge. Participants in the Sustained Care arm receive a free 3-month supply of FDA-approved smoking cessation medication and 5 interactive voice response calls that provide tailored motivational messages, medication refills, and access to a live tobacco treatment counselor. Participants in the Standard Care arm receive a smoking cessation medication recommendation and information about community resources. Outcomes are assessed at 1, 3, and 6 months after discharge. The primary outcome is biochemically-validated tobacco abstinence for the past 7 days at 6

  15. Target Temperature Management after out-of-hospital cardiac arrest--a randomized, parallel-group, assessor-blinded clinical trial--rationale and design

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Wetterslev, Jørn; al-Subaie, Nawaf

    2012-01-01

    Experimental animal studies and previous randomized trials suggest an improvement in mortality and neurologic function with induced hypothermia after cardiac arrest. International guidelines advocate the use of a target temperature management of 32°C to 34°C for 12 to 24 hours after resuscitation...... from out-of-hospital cardiac arrest. A systematic review indicates that the evidence for recommending this intervention is inconclusive, and the GRADE level of evidence is low. Previous trials were small, with high risk of bias, evaluated select populations, and did not treat hyperthermia...... in the control groups. The optimal target temperature management strategy is not known....

  16. Delay line length selection in generating fast random numbers with a chaotic laser.

    Science.gov (United States)

    Zhang, Jianzhong; Wang, Yuncai; Xue, Lugang; Hou, Jiayin; Zhang, Beibei; Wang, Anbang; Zhang, Mingjiang

    2012-04-10

    The chaotic light signals generated by an external cavity semiconductor laser have been experimentally demonstrated to extract fast random numbers. However, the photon round-trip time in the external cavity can cause the occurrence of the periodicity in random sequences. To overcome it, the exclusive-or operation on corresponding random bits in samples of the chaotic signal and its time-delay signal from a chaotic laser is required. In this scheme, the proper selection of delay length is a key issue. By doing a large number of experiments and theoretically analyzing the interplay between the Runs test and the threshold value of the autocorrelation function, we find when the corresponding delay time of autocorrelation trace with the correlation coefficient of less than 0.007 is considered as the delay time between the chaotic signal and its time-delay signal, streams of random numbers can be generated with verified randomness.

  17. Assessment of pharmacy information system performance in selected hospitals in isfahan city during 2011.

    Science.gov (United States)

    Saqaeian Nejad Isfahani, Sakineh; Mirzaeian, Razieh; Habibi, Mahbobe

    2013-01-01

    In supporting a therapeutic approach and medication therapy management, pharmacy information system acts as one of the central pillars of information system. This ensures that medication therapy is being supported and evaluated with an optimal level of safety and quality similar to other treatments and services. This research aims to evaluate the performance of pharmacy information system in three types of teaching, private and social affiliated hospitals. The present study is an applied, descriptive and analytical study which was conducted on the pharmacy information system in use in the selected hospitals. The research population included all the users of pharmacy information systems in the selected hospitals. The research sample is the same as the research population. Researchers collected data using a self-designed checklist developed following the guidelines of the American Society of Health-System Pharmacists, Australia pharmaceutical Society and Therapeutic guidelines of the Drug Commission of the German Medical Association. The checklist validity was assessed by research supervisors and pharmacy information system pharmacists and users. To collect data besides observation, the questionnaires were distributed among pharmacy information system pharmacists and users. Finally, the analysis of the data was performed using the SPSS software. Pharmacy information system was found to be semi-automated in 16 hospitals and automated in 3 ones. Regarding the standards in the guidelines issued by the Society of Pharmacists, the highest rank in observing the input standards belonged to the Social Services associated hospitals with a mean score of 32.75. While teaching hospitals gained the highest score both in processing standards with a mean score of 29.15 and output standards with a mean score of 43.95, and the private hospitals had the lowest mean scores of 23.32, 17.78, 24.25 in input, process and output standards respectively. Based on the findings, the studied

  18. Nicotine patches and quitline counseling to help hospitalized smokers stay quit: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Cummins, Sharon; Zhu, Shu-Hong; Gamst, Anthony; Kirby, Carrie; Brandstein, Kendra; Klonoff-Cohen, Hillary; Chaplin, Edward; Morris, Timothy; Seymann, Gregory; Lee, Joshua

    2012-08-01

    Hospitalized smokers often quit smoking, voluntarily or involuntarily; most relapse soon after discharge. Extended follow-up counseling can help prevent relapse. However, it is difficult for hospitals to provide follow-up and smokers rarely leave the hospital with quitting aids (for example, nicotine patches). This study aims to test a practical model in which hospitals work with a state cessation quitline. Hospital staff briefly intervene with smokers at bedside and refer them to the quitline. Depending on assigned condition, smokers may receive nicotine patches at discharge or extended quitline telephone counseling post-discharge. This project establishes a practical model that lends itself to broader dissemination, while testing the effectiveness of the interventions in a rigorous randomized trial. This randomized clinical trial (N = 1,640) tests the effect of two interventions on long-term quit rates of hospitalized smokers in a 2 x 2 factorial design. The interventions are (1) nicotine patches (eight-week, step down program) dispensed at discharge and (2) proactive telephone counseling provided by the state quitline after discharge. Subjects are randomly assigned into: usual care, nicotine patches, telephone counseling, or both patches and counseling. It is hypothesized that patches and counseling have independent effects and their combined effect is greater than either alone. The primary outcome measure is thirty-day abstinence at six months; a secondary outcome is biochemically validated smoking status. Cost-effectiveness analysis is conducted to compare each intervention condition (patch alone, counseling alone, and combined interventions) against the usual care condition. Further, this study examines whether smokers' medical diagnosis is a moderator of treatment effect. Generalized linear (binomial) mixed models will be used to study the effect of treatment on abstinence rates. Clustering is accounted for with hospital-specific random effects. If this

  19. Nicotine patches and quitline counseling to help hospitalized smokers stay quit: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Cummins Sharon

    2012-08-01

    Full Text Available Abstract Background Hospitalized smokers often quit smoking, voluntarily or involuntarily; most relapse soon after discharge. Extended follow-up counseling can help prevent relapse. However, it is difficult for hospitals to provide follow-up and smokers rarely leave the hospital with quitting aids (for example, nicotine patches. This study aims to test a practical model in which hospitals work with a state cessation quitline. Hospital staff briefly intervene with smokers at bedside and refer them to the quitline. Depending on assigned condition, smokers may receive nicotine patches at discharge or extended quitline telephone counseling post-discharge. This project establishes a practical model that lends itself to broader dissemination, while testing the effectiveness of the interventions in a rigorous randomized trial. Methods/design This randomized clinical trial (N = 1,640 tests the effect of two interventions on long-term quit rates of hospitalized smokers in a 2 x 2 factorial design. The interventions are (1 nicotine patches (eight-week, step down program dispensed at discharge and (2 proactive telephone counseling provided by the state quitline after discharge. Subjects are randomly assigned into: usual care, nicotine patches, telephone counseling, or both patches and counseling. It is hypothesized that patches and counseling have independent effects and their combined effect is greater than either alone. The primary outcome measure is thirty-day abstinence at six months; a secondary outcome is biochemically validated smoking status. Cost-effectiveness analysis is conducted to compare each intervention condition (patch alone, counseling alone, and combined interventions against the usual care condition. Further, this study examines whether smokers’ medical diagnosis is a moderator of treatment effect. Generalized linear (binomial mixed models will be used to study the effect of treatment on abstinence rates. Clustering is accounted

  20. Two-year Randomized Clinical Trial Of Self-etching Adhesives And Selective Enamel Etching

    OpenAIRE

    Pena, MR; Rodrigues CE; JA; Ely; Giannini, C.; Reis, M; AF

    2016-01-01

    Objective: The aim of this randomized, controlled prospective clinical trial was to evaluate the clinical effectiveness of restoring noncarious cervical lesions with two self-etching adhesive systems applied with or without selective enamel etching. Methods: A one-step self-etching adhesive (Xeno V+) and a two-step self-etching system (Clearfil SE Bond) were used. The effectiveness of phosphoric acid selective etching of enamel margins was also evaluated. Fifty-six cavities were restored with...

  1. [Hospitalizations due to ambulatory care sensitive conditions: selection of diagnostic codes for Spain].

    Science.gov (United States)

    Caminal, J; Mundet, X; Ponsà, J; Sánchez, E; Casanova, C

    2001-01-01

    Hospitalisations due to Ambulatory Care Sensitive Conditions (ACSC) are considered an indicator to measure the use of hospital services because of health conditions that could have been prevented and controlled by primary health care. The objective of this study is to select the list of diagnostic codes to assess the performance of primary health care in Spain. The five criteria proposed by Weissman and Solberg, to select an appropriate indicator, were applied to a first list of 87 ACSC diagnostic codes identified through bibliographic search. Information on two main criteria-whether care for a health condition was a primary health care role and whether hospitalisation was needed once the health problem occurred was obtained by means of the Delphi technique. A group of 44 experts gathered together for the study. For the remaining criteria, information came from the results of the Pilot study on hospitalisations due to ACSC in Catalonia, Spain. Meeting the five criteria was the criterion selected to evaluate the solving ability of primary health care. a) from the Delphi group: 42 (95.4%) participants completed the three rounds. The question on whether the care of the selected health conditions was responsibility of primary health care reached a high level of consensus (between 86.1 and 100%). The consensus on the need for hospitalisation was lower, from 75.7 to 88.6%, moreover, 5 diagnostic codes did not reach the established consensus, and b) from the ACSC selection process: five diagnostic codes did not meet the criteria and were excluded. Out of the remaining 82, all them were considered as health problems to be cared for at primary level and in 37 cases hospitalisation was considered always as necessary. Thirty-five diagnostic codes, that met the five criteria, represented the set of ACSC diagnostic codes in our setting. A set of 35 diagnostic codes of ACSC, adapted to our setting, is proposed to evaluate primary health care performance. The selected codes

  2. Economic evaluation of an extended nutritional intervention in older Australian hospitalized patients: a randomized controlled trial.

    Science.gov (United States)

    Sharma, Yogesh; Thompson, Campbell; Miller, Michelle; Shahi, Rashmi; Hakendorf, Paul; Horwood, Chris; Kaambwa, Billingsley

    2018-02-05

    Prevalence of malnutrition in older hospitalized patients is 30%. Malnutrition is associated with poor clinical outcomes in terms of high morbidity and mortality and is costly for hospitals. Extended nutrition interventions improve clinical outcomes but limited studies have investigated whether these interventions are cost-effective. In this randomized controlled trial, 148 malnourished general medical patients ≥60 years were recruited and randomized to receive either an extended nutritional intervention or usual care. Nutrition intervention was individualized and started with 24 h of admission and was continued for 3 months post-discharge with a monthly telephone call whereas control patients received usual care. Nutrition status was confirmed by Patient generated subjective global assessment (PG-SGA) and health-related quality of life (HRQoL) was measured using EuroQoL 5D (EQ-5D-5 L) questionnaire at admission and at 3-months follow-up. A cost-effectiveness analysis was conducted for the primary outcome (incremental costs per unit improvement in PG-SGA) while a cost-utility analysis (CUA) was undertaken for the secondary outcome (incremental costs per quality adjusted life year (QALY) gained). Nutrition status and HRQoL improved in intervention patients. Mean per included patient Australian Medicare costs were lower in intervention group compared to control arm (by $907) but these differences were not statistically significant (95% CI: -$2956 to $4854). The main drivers of higher costs in the control group were higher inpatient ($13,882 versus $13,134) and drug ($838 versus $601) costs. After adjusting outcomes for baseline differences and repeated measures, the intervention was more effective than the control with patients in this arm reporting QALYs gained that were higher by 0.0050 QALYs gained per patient (95% CI: -0.0079 to 0.0199). The probability of the intervention being cost-effective at willingness to pay values as low as $1000 per unit

  3. Relay model for recruiting alcohol dependent patients in general hospitals--a single-blind pragmatic randomized trial

    DEFF Research Database (Denmark)

    Schwarz, Anne-Sophie; Bilberg, Randi; Bjerregaard, Lene Berit Skov

    2016-01-01

    - The Relay Model. METHOD/DESIGN: The study is a single-blind pragmatic randomized controlled trial including patients admitted to the hospital. The study group (n = 500) will receive an intervention, and the control group (n = 500) will be referred to treatment by usual procedures. All patients complete...

  4. Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: a cross sectional study.

    Science.gov (United States)

    Sisay, Mekonnen; Mengistu, Getnet; Molla, Bereket; Amare, Firehiwot; Gabriel, Tesfaye

    2017-02-23

    Despite the complexity of drug use, a number of indicators have been developed, standardized and evaluated by the World Health Organization (WHO). These indicators are grouped in to three categories namely: prescribing indicators, patient care indicators and facility indicators. The study was aimed to evaluate rational drug use based on WHO-core drug use indicators in Dilchora referral hospital, Dire Dawa; Hiwot Fana specialized university hospital, Harar and Karamara general hospital, Jigjiga, eastern Ethiopia. Hospital based quantitative cross sectional study design was employed to evaluate rational drug use based on WHO core drug use indicators in selected hospitals. Systematic random sampling for prescribing indicators and convenient sampling for patient care indicators was employed. Taking WHO recommendations in to account, a total of 1,500 prescription papers (500 from each hospitals) were investigated. In each hospital, 200 outpatient attendants and 30 key essential drugs were also selected using the WHO recommendation. Data were collected using retrospective and prospective structured observational check list. Data were entered to EPI Data Version 3.1, exported and analyzed using SPSS version 16.0. Besides, the data were evaluated as per the WHO guidelines. Statistical significance was determined by one way analysis of variance (ANOVA) for some variables. P-value of less than 0.05 was considered statistically significant. Finally, tabular presentation was used to present the data. Mean, 2.34 (±1.08) drugs were prescribed in the selected hospitals. Prescriptions containing antibiotics and that of injectables were 57.87 and 10.9% respectively. The average consultation and dispensing time were 276.5 s and 61.12 s respectively. Besides, 75.77% of the prescribed drugs were actually dispensed. Only 3.3% of prescriptions were adequately labeled and 75.7% patients know about the dosage of the prescription. Not more than, 20(66.7%) key drugs were available in

  5. A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits

    Science.gov (United States)

    Takahashi, Paul Y.; Pecina, Jennifer L.; Upatising, Benjavan; Chaudhry, Rajeev; Shah, Nilay D.; Van Houten, Holly; Cha, Steve; Croghan, Ivana; Naessens, James M.; Hanson, Gregory J.

    2014-01-01

    Background Efficiently caring for frail, older adults will become an increasingly important part of healthcare reform; telemonitoring within homes may be an answer to improve outcomes. This study sought to determine the difference in hospitalizations and emergency room (ER) visits in older adults using telemonitoring versus usual care. Methods This was a randomized trial of adults older than 60 years with high-risk for rehospitalization. Subjects were randomized to telemonitoring with daily input versus patient-driven usual care. Telemonitoring was accomplished by daily biometrics, symptom reporting and videoconference. The primary outcome included a composite end-point of hospitalization and ER visits in the 12 months following enrollment. Secondary end-points included hospital days, hospital admissions, and ER visits. Intention to treat analysis was performed. Results Two hundred and five subjects were enrolled with a mean age of 80.3 years. There was no difference in hospitalizations and ER visits between the telemonitoring group (63.7%) and the group receiving usual care (57.3%) (P value 0.345). There was no difference in individual outcomes including hospital days, hospital admissions and ER visits. There also was no significant change between hospitalizations and ER visits in the pre-enrollment and post-enrollment period. Mortality was higher in the telemonitoring group (14.7%), compared to usual care (3.9%) (P value 0.008). Conclusions Among elderly patients, telemonitoring did not result in lower hospitalizations or ER visits. There were no differences determined within the secondary outcomes. The cause of the mortality difference is unknown. PMID:22507696

  6. A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants.

    Science.gov (United States)

    Flores, Pedro; Mendes, Ana Luisa; Neto, Ana S

    2016-04-01

    Acute bronchiolitis is a common disorder of infants that often results in hospitalization. Apart from supportive care, no therapy has been shown to influence the course of the disease, except for a possible effect of nebulized hypertonic saline (HS). To determine whether this does have beneficial effects on length of stay in hospital or on severity scores, we undertook a double-blind, randomized, controlled trial in a pediatric department of a Portuguese hospital. Previously healthy infants, younger than 12 months, hospitalized with mild-to-moderate acute viral bronchiolitis were randomized to receive either nebulized 3% (hypertonic, HS) or 0.9% (normal, NS) saline during their entire hospital stay. Primary endpoints were: length of hospital stay and severity scores on each day of hospitalization. Need for supplemental oxygen, further add-on medications and adverse effects were also analyzed. Sixty-eight patients completed the study (HS: 33; NS: 35). The median length of hospital stay did not differ between groups: HS: 5.6 ± 2.3 days; NS: 5.4 ± 2.1 days (P = 0.747). We found no difference between groups in severity scores from day 1 to day 4. There were no differences in need for supplemental oxygen or add-on medications. Patients in HS group had significantly more cough (46% vs. 20%, P = 0.025) and rhinorrhoe (58% vs. 31%, P = 0.30). This study does not support the use of nebulized HS over NS in therapy of hospitalized children with mild-to-moderate acute viral bronchiolitis. © 2015 Wiley Periodicals, Inc.

  7. Hebbian Learning in a Random Network Captures Selectivity Properties of the Prefrontal Cortex.

    Science.gov (United States)

    Lindsay, Grace W; Rigotti, Mattia; Warden, Melissa R; Miller, Earl K; Fusi, Stefano

    2017-11-08

    Complex cognitive behaviors, such as context-switching and rule-following, are thought to be supported by the prefrontal cortex (PFC). Neural activity in the PFC must thus be specialized to specific tasks while retaining flexibility. Nonlinear "mixed" selectivity is an important neurophysiological trait for enabling complex and context-dependent behaviors. Here we investigate (1) the extent to which the PFC exhibits computationally relevant properties, such as mixed selectivity, and (2) how such properties could arise via circuit mechanisms. We show that PFC cells recorded from male and female rhesus macaques during a complex task show a moderate level of specialization and structure that is not replicated by a model wherein cells receive random feedforward inputs. While random connectivity can be effective at generating mixed selectivity, the data show significantly more mixed selectivity than predicted by a model with otherwise matched parameters. A simple Hebbian learning rule applied to the random connectivity, however, increases mixed selectivity and enables the model to match the data more accurately. To explain how learning achieves this, we provide analysis along with a clear geometric interpretation of the impact of learning on selectivity. After learning, the model also matches the data on measures of noise, response density, clustering, and the distribution of selectivities. Of two styles of Hebbian learning tested, the simpler and more biologically plausible option better matches the data. These modeling results provide clues about how neural properties important for cognition can arise in a circuit and make clear experimental predictions regarding how various measures of selectivity would evolve during animal training. SIGNIFICANCE STATEMENT The prefrontal cortex is a brain region believed to support the ability of animals to engage in complex behavior. How neurons in this area respond to stimuli-and in particular, to combinations of stimuli ("mixed

  8. Selecting Optimal Parameters of Random Linear Network Coding for Wireless Sensor Networks

    DEFF Research Database (Denmark)

    Heide, Janus; Zhang, Qi; Fitzek, Frank

    2013-01-01

    This work studies how to select optimal code parameters of Random Linear Network Coding (RLNC) in Wireless Sensor Networks (WSNs). With Rateless Deluge [1] the authors proposed to apply Network Coding (NC) for Over-the-Air Programming (OAP) in WSNs, and demonstrated that with NC a significant...

  9. Evaluating the angina plan in patients admitted to hospital with angina: a randomized controlled trial.

    Science.gov (United States)

    Zetta, Stella; Smith, Karen; Jones, Martyn; Allcoat, Paul; Sullivan, Frank

    2011-04-01

    The aim of this trial was to evaluate the Angina Plan (AP), a cognitive-behavioral nurse-facilitated self-help intervention against standard care (SC). A randomized controlled trial of 218 patients hospitalized with angina assessed participants predischarge and 6 months later. Data were collected during a structured interview using validated questionnaires, self-report, and physiological measurement to assess between group changes in mood, knowledge and misconceptions, cardiovascular risk, symptoms, quality of life, and health service utilization. The intention-to-treat (ITT) analysis found no reliable effects on anxiety and depression at 6 months. AP participants reported increased knowledge, less misconceptions, reduced body mass index (BMI), an increase in self-reported exercise, less functional limitation, and improvements in general health perceptions and social and leisure activities compared to those receiving SC. Sensitivity analysis excluding participants with high baseline depression revealed a statistical significant reduction in depression levels in AP compared to the SC participants. Analysis excluding participants receiving cardiac surgery or angioplasty removed the ITT effects on physical limitation, self-reported exercise and general health perceptions and the improvements seen in social and leisure activities, while adaptive effects on knowledge, misconceptions and BMI remained and between-group changes in depression approached significance. Initiating the AP in a secondary care setting for patients with new and existing angina produces similar benefits to those reported in newly diagnosed primary care patients. Further evaluation is required to examine the extent of observed effects in the longer term. © 2009 Blackwell Publishing Ltd.

  10. Randomized trial of a secondhand smoke exposure reduction intervention among hospital-based pregnant women.

    Science.gov (United States)

    Chi, Ying-Chen; Wu, Chen-Long; Chen, Cheng-Yu; Lyu, Shu-Yu; Lo, Feng-En; Morisky, Donald E

    2015-02-01

    This study sought to assess the effectiveness of a secondhand tobacco smoke (SHS) prevention program based on an expanded Health Belief Model (HBM) incorporating self-efficacy among pregnant women in a hospital setting in Taiwan. This study utilized a two-group longitudinal randomized controlled trial design. Participants in the intervention group (n=50) enrolled in a SHS prevention program based on the HBM, while participants in the comparison group (n=50) received standard government-mandated counseling care. Both groups were given questionnaires as a pre-test, two weeks into the intervention, and one month following the conclusion of the intervention. The questionnaire and intervention were developed based on the understanding gained through a series of in-depth interviews and a focus-group conducted among pregnant women. Exhaled carbon monoxide was also measured and used as a proxy for SHS exposure. Intervention group scores were all significantly higher than comparison group scores (pwomen regarding the harms of SHS while both empowering and equipping them with the tools to confront their family members and effectively reduce their SHS exposure while promoting smoke-free social norms. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Effectiveness of chest physiotherapy in infants hospitalized with acute bronchiolitis: a multicenter, randomized, controlled trial.

    Science.gov (United States)

    Gajdos, Vincent; Katsahian, Sandrine; Beydon, Nicole; Abadie, Véronique; de Pontual, Loïc; Larrar, Sophie; Epaud, Ralph; Chevallier, Bertrand; Bailleux, Sylvain; Mollet-Boudjemline, Alix; Bouyer, Jean; Chevret, Sylvie; Labrune, Philippe

    2010-09-28

    Acute bronchiolitis treatment in children and infants is largely supportive, but chest physiotherapy is routinely performed in some countries. In France, national guidelines recommend a specific type of physiotherapy combining the increased exhalation technique (IET) and assisted cough (AC). Our objective was to evaluate the efficacy of chest physiotherapy (IET + AC) in previously healthy infants hospitalized for a first episode of acute bronchiolitis. We conducted a multicenter, randomized, outcome assessor-blind and parent-blind trial in seven French pediatric departments. We recruited 496 infants hospitalized for first-episode acute bronchiolitis between October 2004 and January 2008. Patients were randomly allocated to receive from physiotherapists three times a day, either IET + AC (intervention group, n=246) or nasal suction (NS, control group, n=250). Only physiotherapists were aware of the allocation group of the infant. The primary outcome was time to recovery, defined as 8 hours without oxygen supplementation associated with minimal or no chest recession, and ingesting more than two-thirds of daily food requirements. Secondary outcomes were intensive care unit admissions, artificial ventilation, antibiotic treatment, description of side effects during procedures, and parental perception of comfort. Statistical analysis was performed on an intent-to-treat basis. Median time to recovery was 2.31 days, (95% confidence interval [CI] 1.97-2.73) for the control group and 2.02 days (95% CI 1.96-2.34) for the intervention group, indicating no significant effect of physiotherapy (hazard ratio [HR]=1.09, 95% CI 0.91-1.31, p=0.33). No treatment by age interaction was found (p=0.97). Frequency of vomiting and transient respiratory destabilization was higher in the IET + AC group during the procedure (relative risk [RR]=10.2, 95% CI 1.3-78.8, p=0.005 and RR=5.4, 95% CI 1.6-18.4, p=0.002, respectively). No difference between groups in bradycardia with or without

  12. Effectiveness of chest physiotherapy in infants hospitalized with acute bronchiolitis: a multicenter, randomized, controlled trial.

    Directory of Open Access Journals (Sweden)

    Vincent Gajdos

    2010-09-01

    Full Text Available Acute bronchiolitis treatment in children and infants is largely supportive, but chest physiotherapy is routinely performed in some countries. In France, national guidelines recommend a specific type of physiotherapy combining the increased exhalation technique (IET and assisted cough (AC. Our objective was to evaluate the efficacy of chest physiotherapy (IET + AC in previously healthy infants hospitalized for a first episode of acute bronchiolitis.We conducted a multicenter, randomized, outcome assessor-blind and parent-blind trial in seven French pediatric departments. We recruited 496 infants hospitalized for first-episode acute bronchiolitis between October 2004 and January 2008. Patients were randomly allocated to receive from physiotherapists three times a day, either IET + AC (intervention group, n=246 or nasal suction (NS, control group, n=250. Only physiotherapists were aware of the allocation group of the infant. The primary outcome was time to recovery, defined as 8 hours without oxygen supplementation associated with minimal or no chest recession, and ingesting more than two-thirds of daily food requirements. Secondary outcomes were intensive care unit admissions, artificial ventilation, antibiotic treatment, description of side effects during procedures, and parental perception of comfort. Statistical analysis was performed on an intent-to-treat basis. Median time to recovery was 2.31 days, (95% confidence interval [CI] 1.97-2.73 for the control group and 2.02 days (95% CI 1.96-2.34 for the intervention group, indicating no significant effect of physiotherapy (hazard ratio [HR]=1.09, 95% CI 0.91-1.31, p=0.33. No treatment by age interaction was found (p=0.97. Frequency of vomiting and transient respiratory destabilization was higher in the IET + AC group during the procedure (relative risk [RR]=10.2, 95% CI 1.3-78.8, p=0.005 and RR=5.4, 95% CI 1.6-18.4, p=0.002, respectively. No difference between groups in bradycardia with or

  13. Effectiveness of Chest Physiotherapy in Infants Hospitalized with Acute Bronchiolitis: A Multicenter, Randomized, Controlled Trial

    Science.gov (United States)

    Gajdos, Vincent; Katsahian, Sandrine; Beydon, Nicole; Abadie, Véronique; de Pontual, Loïc; Larrar, Sophie; Epaud, Ralph; Chevallier, Bertrand; Bailleux, Sylvain; Mollet-Boudjemline, Alix; Bouyer, Jean; Chevret, Sylvie; Labrune, Philippe

    2010-01-01

    Background Acute bronchiolitis treatment in children and infants is largely supportive, but chest physiotherapy is routinely performed in some countries. In France, national guidelines recommend a specific type of physiotherapy combining the increased exhalation technique (IET) and assisted cough (AC). Our objective was to evaluate the efficacy of chest physiotherapy (IET + AC) in previously healthy infants hospitalized for a first episode of acute bronchiolitis. Methods and Findings We conducted a multicenter, randomized, outcome assessor-blind and parent-blind trial in seven French pediatric departments. We recruited 496 infants hospitalized for first-episode acute bronchiolitis between October 2004 and January 2008. Patients were randomly allocated to receive from physiotherapists three times a day, either IET + AC (intervention group, n = 246) or nasal suction (NS, control group, n = 250). Only physiotherapists were aware of the allocation group of the infant. The primary outcome was time to recovery, defined as 8 hours without oxygen supplementation associated with minimal or no chest recession, and ingesting more than two-thirds of daily food requirements. Secondary outcomes were intensive care unit admissions, artificial ventilation, antibiotic treatment, description of side effects during procedures, and parental perception of comfort. Statistical analysis was performed on an intent-to-treat basis. Median time to recovery was 2.31 days, (95% confidence interval [CI] 1.97–2.73) for the control group and 2.02 days (95% CI 1.96–2.34) for the intervention group, indicating no significant effect of physiotherapy (hazard ratio [HR]  = 1.09, 95% CI 0.91–1.31, p = 0.33). No treatment by age interaction was found (p = 0.97). Frequency of vomiting and transient respiratory destabilization was higher in the IET + AC group during the procedure (relative risk [RR]  = 10.2, 95% CI 1.3–78.8, p = 0.005 and RR  = 5.4, 95% CI 1.6–18

  14. Selection of hospital antimicrobial prescribing quality indicators: a consensus among German antibiotic stewardship (ABS) networkers.

    Science.gov (United States)

    Thern, J; de With, K; Strauss, R; Steib-Bauert, M; Weber, N; Kern, W V

    2014-04-01

    Simple, valid, and evidence-based indicators to measure the quality of antimicrobial prescribing in acute-care hospitals are urgently needed and increasingly requested by policymakers. The aim of this study was to develop new consensus quality indicators (QIs) for hospital antibiotic stewardship (ABS) and infection management which will be further evaluated for internal quality management and external quality assessment in Germany. Based on an extensive literature review, the Austrian-German hospital ABS Guideline Committee and selected members of the German ABS Expert Network discussed and drafted a list of 99 potential indicators for hospitals that reflect structural prerequisites for ABS (35 items), ABS core activities (18 items), additional ABS measures (5 items), and process of care indicators (both generic and disease-specific-12 and 29 items, respectively). Questionnaires were mailed to German ABS experts and healthcare professionals with further education in ABS. Participants scored (on a nine-point Likert scale) relevance (clinical, ecological/resistance, economical/expenses) and presumed practicability (six categories: clarity of definition, effort to collect data, barrier to implementation, verifiability, suitability for external quality assessment, quality gap), taking into account their local work environment. The scores were processed according to the RAND/UCLA appropriateness method, and QIs were judged relevant if the median (clinical + ecological and/or economical) scores were >6. The indicators thus assessed to be potentially relevant were then filtered according to their practicability. Highly relevant QIs with borderline practicability scores and items with disagreements and overlapping areas were re-discussed in a final multidisciplinary panel consensus workshop convened in November 2012. Of the 340 questionnaires that were mailed, 75 questionnaires were completed and returned. Of 99 initially proposed items, 32 were excluded due to

  15. Tehran Air Pollutants Prediction Based on Random Forest Feature Selection Method

    Science.gov (United States)

    Shamsoddini, A.; Aboodi, M. R.; Karami, J.

    2017-09-01

    Air pollution as one of the most serious forms of environmental pollutions poses huge threat to human life. Air pollution leads to environmental instability, and has harmful and undesirable effects on the environment. Modern prediction methods of the pollutant concentration are able to improve decision making and provide appropriate solutions. This study examines the performance of the Random Forest feature selection in combination with multiple-linear regression and Multilayer Perceptron Artificial Neural Networks methods, in order to achieve an efficient model to estimate carbon monoxide and nitrogen dioxide, sulfur dioxide and PM2.5 contents in the air. The results indicated that Artificial Neural Networks fed by the attributes selected by Random Forest feature selection method performed more accurate than other models for the modeling of all pollutants. The estimation accuracy of sulfur dioxide emissions was lower than the other air contaminants whereas the nitrogen dioxide was predicted more accurate than the other pollutants.

  16. TEHRAN AIR POLLUTANTS PREDICTION BASED ON RANDOM FOREST FEATURE SELECTION METHOD

    Directory of Open Access Journals (Sweden)

    A. Shamsoddini

    2017-09-01

    Full Text Available Air pollution as one of the most serious forms of environmental pollutions poses huge threat to human life. Air pollution leads to environmental instability, and has harmful and undesirable effects on the environment. Modern prediction methods of the pollutant concentration are able to improve decision making and provide appropriate solutions. This study examines the performance of the Random Forest feature selection in combination with multiple-linear regression and Multilayer Perceptron Artificial Neural Networks methods, in order to achieve an efficient model to estimate carbon monoxide and nitrogen dioxide, sulfur dioxide and PM2.5 contents in the air. The results indicated that Artificial Neural Networks fed by the attributes selected by Random Forest feature selection method performed more accurate than other models for the modeling of all pollutants. The estimation accuracy of sulfur dioxide emissions was lower than the other air contaminants whereas the nitrogen dioxide was predicted more accurate than the other pollutants.

  17. Significance of a Level-2, "selective, secondary evacuation" hospital during a peripheral town terrorist attack.

    Science.gov (United States)

    Schwartz, Dagan; Pinkert, Moshe; Leiba, Adi; Oren, Meir; Haspel, Jacob; Levi, Yehezkel; Goldberg, Avishay; Bar-Dayan, Yaron

    2007-01-01

    were able to treat and evacuate all severely and moderately injured patients within 17 minutes of the explosion. A total of 12 of the 21 ambulances arriving on-scene within the first 20 minutes were staffed by EMS volunteers or off-duty workers. When a MCI occurs in a small town that is in the vicinity of a Level-2 Trauma Center, and located a > 40 minute drive from Level-1 Trauma Centers, the Level-2 Trauma Center is a critical component in medical management of the event. All severely and moderately injured patients initially should be evacuated to the Level-2 Trauma Center, and given advanced, hospital-based resuscitation. The patients needing care beyond the capabilities of this facility should be distributed secondarily to Level-1 Trauma Centers. To alleviate the burden placed on the local hospital, some of the mildly injured victims can be evacuated primarily to more distant hospitals. The ability to control the flow of mildly injured patients is limited by the large percentage of them arriving by private cars. The availability of EMS in small towns can be augmented significantly by enrolling off-duty EMS workers and volunteers to the rescue effort. Level-2 hospitals in small towns should be prepared and drilled to operate in a "selective evacuation" mode during MCIs.

  18. Classification of epileptic EEG signals based on simple random sampling and sequential feature selection.

    Science.gov (United States)

    Ghayab, Hadi Ratham Al; Li, Yan; Abdulla, Shahab; Diykh, Mohammed; Wan, Xiangkui

    2016-06-01

    Electroencephalogram (EEG) signals are used broadly in the medical fields. The main applications of EEG signals are the diagnosis and treatment of diseases such as epilepsy, Alzheimer, sleep problems and so on. This paper presents a new method which extracts and selects features from multi-channel EEG signals. This research focuses on three main points. Firstly, simple random sampling (SRS) technique is used to extract features from the time domain of EEG signals. Secondly, the sequential feature selection (SFS) algorithm is applied to select the key features and to reduce the dimensionality of the data. Finally, the selected features are forwarded to a least square support vector machine (LS_SVM) classifier to classify the EEG signals. The LS_SVM classifier classified the features which are extracted and selected from the SRS and the SFS. The experimental results show that the method achieves 99.90, 99.80 and 100 % for classification accuracy, sensitivity and specificity, respectively.

  19. Pre-hospital electrocardiogram triage with telemedicine near halves time to treatment in STEMI: A meta-analysis and meta-regression analysis of non-randomized studies.

    Science.gov (United States)

    Brunetti, Natale Daniele; De Gennaro, Luisa; Correale, Michele; Santoro, Francesco; Caldarola, Pasquale; Gaglione, Antonio; Di Biase, Matteo

    2017-04-01

    A shorter time to treatment has been shown to be associated with lower mortality rates in acute myocardial infarction (AMI). Several strategies have been adopted with the aim to reduce any delay in diagnosis of AMI: pre-hospital triage with telemedicine is one of such strategies. We therefore aimed to measure the real effect of pre-hospital triage with telemedicine in case of AMI in a meta-analysis study. We performed a meta-analysis of non-randomized studies with the aim to quantify the exact reduction of time to treatment achieved by pre-hospital triage with telemedicine. Data were pooled and compared by relative time reduction and 95% C.I.s. A meta-regression analysis was performed in order to find possible predictors of shorter time to treatment. Eleven studies were selected and finally evaluated in the study. The overall relative reduction of time to treatment with pre-hospital triage and telemedicine was -38/-40% (ptriage with telemedicine is associated with a near halved time to treatment in AMI. The benefit is larger in terms of absolute time to treatment reduction in populations with larger delays to treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Delirium Outcomes in a Randomized Trial of Blood Transfusion Thresholds Among Hospitalized Older Patients with Hip Fracture

    Science.gov (United States)

    Gruber-Baldini, Ann L; Marcantonio, Edward; Orwig, Denise; Magaziner, Jay; Terrin, Michael; Barr, Erik; Brown, Jessica Pelletier; Paris, Barbara; Zagorin, Aleksandra; Roffey, Darren M.; Zakriya, Khwaja; Blute, Mary-Rita; Hebel, J. Richard; Carson, Jeffrey L.

    2013-01-01

    Objectives To determine if a higher blood transfusion threshold would prevent new or worsening delirium symptoms in the hospital after hip fracture surgery. Design Ancillary study to a randomized clinical trial. Setting Thirteen hospitals in United States and Canada. Participants One-hundred-thirty-nine hospitalized hip fracture patients, age ≥50, with cardiovascular disease or risk factors, and hemoglobin10 g/dL; 2) Restrictive: received transfusions if developed symptoms of anemia or hemoglobin fell below 8 g/dL. Measurements Delirium assessments performed pre-randomization and up to three times post-randomization. Primary outcome: Severity of delirium using Memorial Delirium Assessment Scale (MDAS) scale. Secondary outcome: presence or absence of delirium defined by Confusion Assessment Method Diagnostic Algorithm (CAM). Results Mean age was 81.5 (SD=9.1). Liberal group received a median 2 units and Restrictive group 0 units of blood. Hemoglobin concentration on day 1 post randomization was 1.4 g/dL higher in the Liberal group. Treatment groups did not significantly differ at any time point or over time on either MDAS delirium severity (p=0.28) or CAM delirium presence (p=0.83). Conclusion Blood transfusion to maintain hemoglobin >10 g/dL alone is unlikely to influence delirium severity or rate in postoperative hip fracture patients with hemoglobin concentration <10 g/dL. Trial Registration ClinicalTrials.gov identifier: NCT00071032 http://clinicaltrials.gov/ct2/show/NCT00071032 PMID:23898894

  1. Personal name in Igbo Culture: A dataset on randomly selected personal names and their statistical analysis.

    Science.gov (United States)

    Okagbue, Hilary I; Opanuga, Abiodun A; Adamu, Muminu O; Ugwoke, Paulinus O; Obasi, Emmanuela C M; Eze, Grace A

    2017-12-01

    This data article contains the statistical analysis of Igbo personal names and a sample of randomly selected of such names. This was presented as the following: 1). A simple random sampling of some Igbo personal names and their respective gender associated with each name. 2). The distribution of the vowels, consonants and letters of alphabets of the personal names. 3). The distribution of name length. 4). The distribution of initial and terminal letters of Igbo personal names. The significance of the data was discussed.

  2. Spiritual Leadership and Job Involvement of Employees in Selected Hospitals of Isfahan: 2010

    Directory of Open Access Journals (Sweden)

    Hassan Jafari

    2013-09-01

    Full Text Available Background and purpose: The movement of spiritual leadership is a special kind of service-centered leadership which looks forward to progress and staff control. Job involvement also emphasizes timely attendance of staff, feeling successful at work, and sense of optimism and success about the future of the organization. Therefore, this study investigated the relation between spiritual leadership and job involvement of employees in the selected hospitals located in Isfahan. Materials and Methods: This study was descriptive–analytical and was conducted in 7 hospitals of Isfahan in 2010. The instrument used was a valid and reliable questionnaire consisting of three parts of demographic data, spiritual leadership questionnaire, and job involvement. Data was analyzed by SPSS .18 and analytical and descriptive statistics (t-test, ANOVA and Pearson correlation were performed. Results: Results showed that the average score of spiritual leadership and job involvement in entire hospital cases were more than 3. There was a direct correlation between spiritual leadership and job involvement. Also there was a significant relation between the staff work experience and the two studied components. Conclusion: According to the results, it is recommended that organizations authorities involved in health issue provide conditions in addition to focusing on various aspects of spiritual leadership so that the health community rights and especially the staff of this sector be respected and have a sense of job security so that more improvement of job commitment and job involvement be provided for people by enjoying social supports.

  3. Effects of an Intervention to Reduce Hospitalizations From Nursing Homes: A Randomized Implementation Trial of the INTERACT Program.

    Science.gov (United States)

    Kane, Robert L; Huckfeldt, Peter; Tappen, Ruth; Engstrom, Gabriella; Rojido, Carolina; Newman, David; Yang, Zhiyou; Ouslander, Joseph G

    2017-09-01

    Medicare payment initiatives are spurring efforts to reduce potentially avoidable hospitalizations. To determine whether training and support for implementation of a nursing home (NH) quality improvement program (Interventions to Reduce Acute Care Transfers [INTERACT]) reduced hospital admissions and emergency department (ED) visits. This analysis compared changes in hospitalization and ED visit rates between the preintervention and postintervention periods for NHs randomly assigned to receive training and implementation support on INTERACT to changes in control NHs. The analysis focused on 85 NHs (36 717 NH residents) that reported no use of INTERACT during the preintervention period. The study team provided training and support for implementing INTERACT, which included tools that help NH staff identify and evaluate acute changes in NH resident condition and document communication between physicians; care paths to avoid hospitalization when safe and feasible; and advance care planning and quality improvement tools. All-cause hospitalizations, hospitalizations considered potentially avoidable, 30-day hospital readmissions, and ED visits without admission. All-cause hospitalization rates were calculated for all resident-days, high-risk days (0-30 days after NH admission), and lower-risk days (≥31 days after NH admission). We found that of 85 NHs, those that received implementation training and support exhibited statistically nonsignificant reductions in hospitalization rates compared with control NHs (net difference, -0.13 per 1000 resident-days; P = .25), hospitalizations during the first 30 days after NH admission (net difference, -0.37 per 1000 resident-days; P = .48), hospitalizations during periods more than 30 days after NH admission (net difference, -0.09 per 1000 resident-days; P = .39), 30-day readmission rates (net change in rate among hospital discharges, -0.01; P = .36), and ED visits without admission (net difference, 0.02 per 1000

  4. Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Fellows Jeffrey L

    2012-08-01

    Full Text Available Abstract Background Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of ‘forced abstinence’ for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231. Methods/Design The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW and at Oregon Health & Science University (OHSU hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR follow-up calls, compared to usual care inpatient counseling (UC. In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed

  5. Vancomycin gene selection in the microbiome of urban Rattus norvegicus from hospital environment.

    Science.gov (United States)

    Hansen, Thomas Arn; Joshi, Tejal; Larsen, Anders Rhod; Andersen, Paal Skytt; Harms, Klaus; Mollerup, Sarah; Willerslev, Eske; Fuursted, Kurt; Nielsen, Lars Peter; Hansen, Anders Johannes

    2016-01-01

    Widespread use of antibiotics has resulted in selection pressure on genes that make bacteria non-responsive to antibiotics. These antibiotic-resistant bacteria are currently a major threat to global health. There are various possibilities for the transfer of antibiotic resistance genes. It has been argued that animal vectors such as Rattus norvegicus (R. norvegicus) living in hospital sewage systems are ideal for carrying pathogens responsible for fatal diseases in humans. Using a metagenomic sequencing approach, we investigated faecal samples of R. norvegicus from three major cities for the presence of antibiotic resistance genes. We show that despite the shared resistome within samples from the same geographic locations, samples from hospital area carry significantly abundant vancomycin resistance genes. The observed pattern is consistent with a selection for vancomycin genes in the R. norvegicus microbiome, potentially driven by the outflow of antibiotics and antibiotic-resistant bacteria into the wastewater systems. Carriage of vancomycin resistance may suggest that R. norvegicus is acting as a reservoir for possible transmission to the human population. © The Author(s) 2016. Published by Oxford University Press on behalf of the Foundation for Evolution, Medicine, and Public Health.

  6. The effect of fines on nonattendance in public hospital outpatient clinics: study protocol for a randomized controlled trial

    DEFF Research Database (Denmark)

    Blæhr, Emely; Kristensen, Thomas; Væggemose, Ulla

    2016-01-01

    . Various reminder systems have been shown to moderately reduce nonattendance, although the effect of issuing fines for nonattendance has not yet been tested in a randomized context. However, such use of financial incentives could impact access to care differently across the different socioeconomic groups....... The aim of this study is to assess the effect of fines on hospital outpatient nonattendance. Methods/design A 1:1 randomized controlled trial of scheduled outpatient appointments was used, with follow-ups until the date of appointment. The setting is an orthopedic clinic at a regional hospital in Denmark......, the intervention costs and production value of nonattended appointments will be measured. An analysis of effect and cost-effectiveness will be conducted based on a 5 % significance level. Discussion The study is initiated and funded by the Danish Regions, which have the responsibility for the Danish public...

  7. Simulated Performance Evaluation of a Selective Tracker Through Random Scenario Generation

    DEFF Research Database (Denmark)

    Hussain, Dil Muhammad Akbar

    2006-01-01

      The paper presents a simulation study on the performance of a target tracker using selective track splitting filter algorithm through a random scenario implemented on a digital signal processor.  In a typical track splitting filter all the observation which fall inside a likelihood ellipse...... are used for update, however, in our proposed selective track splitting filter less number of observations are used for track update.  Much of the previous performance work [1] has been done on specific (deterministic) scenarios. One of the reasons for considering the specific scenarios, which were...

  8. Classification of epileptic EEG signals based on simple random sampling and sequential feature selection

    OpenAIRE

    Ghayab, Hadi Ratham Al; Li, Yan; Abdulla, Shahab; Diykh, Mohammed; Wan, Xiangkui

    2016-01-01

    Electroencephalogram (EEG) signals are used broadly in the medical fields. The main applications of EEG signals are the diagnosis and treatment of diseases such as epilepsy, Alzheimer, sleep problems and so on. This paper presents a new method which extracts and selects features from multi-channel EEG signals. This research focuses on three main points. Firstly, simple random sampling (SRS) technique is used to extract features from the time domain of EEG signals. Secondly, the sequential fea...

  9. Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial.

    Science.gov (United States)

    Richter, Kimber P; Faseru, Babalola; Mussulman, Laura M; Ellerbeck, Edward F; Shireman, Theresa I; Hunt, Jamie J; Carlini, Beatriz H; Preacher, Kristopher J; Ayars, Candace L; Cook, David J

    2012-08-01

    Post-discharge support is a key component of effective treatment for hospitalized smokers, but few hospitals provide it. Many hospitals and care settings fax-refer smokers to quitlines for follow-up; however, less than half of fax-referred smokers are successfully contacted and enrolled in quitline services. "Warm handoff" is a novel approach to care transitions in which health care providers directly link patients with substance abuse problems with specialists, using face-to-face or phone transfer. Warm handoff achieves very high rates of treatment enrollment for these vulnerable groups. The aim of this study-"EQUIP" (Enhancing Quitline Utilization among In-Patients)-is to determine the effectiveness, and cost-effectiveness, of warm handoff versus fax referral for linking hospitalized smokers with tobacco quitlines. This study employs a two-arm, individually randomized design. It is set in two large Kansas hospitals that have dedicated tobacco treatment interventionists on staff. At each site, smokers who wish to remain abstinent after discharge will be randomly assigned to groups. For patients in the fax group, staff will provide standard in-hospital intervention and will fax-refer patients to the state tobacco quitline for counseling post-discharge. For patients in the warm handoff group, staff will provide brief in-hospital intervention and immediate warm handoff: staff will call the state quitline, notify them that a warm handoff inpatient from Kansas is on the line, then transfer the call to the patients' mobile or bedside hospital phone for quitline enrollment and an initial counseling session. Following the quitline session, hospital staff provides a brief check-back visit. Outcome measures will be assessed at 1, 6, and 12 months post enrollment. Costs are measured to support cost-effectiveness analyses. We hypothesize that warm handoff, compared to fax referral, will improve care transitions for tobacco treatment, enroll more participants in quitline

  10. Effectiveness of audiovisual interventions on stress responses in adolescents with ENT surgery in hospital: randomized controlled trial protocol.

    Science.gov (United States)

    Liu, Cai Yun; Xu, Lei; Zang, Yu Li

    2014-06-01

    To investigate the circadian pattern of cortisol secretion and other stress indictors in association with audiovisual stimuli in adolescents having otorhinolaryngological surgery in hospital. Hospitalization for surgery is a major stressful life event for adolescents causing negative consequences, including anxiety. Recent studies suggest that entertaining and educational interventions might be effective at reducing such adversities, but little is known about the pattern of these responses and effects. Randomized controlled trial. Adolescents with otorhinolaryngological surgery in hospital without any contraindictions for salivary cortisol enzyme immunoassays will be recruited and randomly allocated to experimental, placebo and control. Stress indicators will be collected regularly for 5 days. Standard audiovisual interventions will be displayed for experimental and placebo groups including a simultaneous video-recording of facial and behavioural changes on the second afternoon postadmission and stress indicators will be collected pre- and three times with 20-minute interval postintervention. Follow-up will be conducted to evaluate the longer term effects at 2 weeks, 1-month and 3 months postadmission, respectively. Descriptive and comparative analyses of stress indicators will be performed to examine group differences. Competitive funding was obtained from the Independent Innovation Foundation of Shandong University for interdisciplinary research in 2012. This study will help identify timeslots for interventions for integrating strength-building into stress response reduction in adolescents hospitalized for surgery. © 2013 John Wiley & Sons Ltd.

  11. Hospital

    African Journals Online (AJOL)

    treatment modality. Design: It is a retrospective study of all confirmed. Burkitt's lymphoma of the head and neck region seen at the Obafemi Awolowo University Teaching Hospital Ile. Ife (OAUTHC) between 1986 and 2002. Patients and methods: The medical records of all the patients with the histopathologically confirmed ...

  12. Statistical inference of selection and divergence from a time-dependent Poisson random field model.

    Directory of Open Access Journals (Sweden)

    Amei Amei

    Full Text Available We apply a recently developed time-dependent Poisson random field model to aligned DNA sequences from two related biological species to estimate selection coefficients and divergence time. We use Markov chain Monte Carlo methods to estimate species divergence time and selection coefficients for each locus. The model assumes that the selective effects of non-synonymous mutations are normally distributed across genetic loci but constant within loci, and synonymous mutations are selectively neutral. In contrast with previous models, we do not assume that the individual species are at population equilibrium after divergence. Using a data set of 91 genes in two Drosophila species, D. melanogaster and D. simulans, we estimate the species divergence time t(div = 2.16 N(e (or 1.68 million years, assuming the haploid effective population size N(e = 6.45 x 10(5 years and a mean selection coefficient per generation μ(γ = 1.98/N(e. Although the average selection coefficient is positive, the magnitude of the selection is quite small. Results from numerical simulations are also presented as an accuracy check for the time-dependent model.

  13. Selection bias and subject refusal in a cluster-randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Rochelle Yang

    2017-07-01

    Full Text Available Abstract Background Selection bias and non-participation bias are major methodological concerns which impact external validity. Cluster-randomized controlled trials are especially prone to selection bias as it is impractical to blind clusters to their allocation into intervention or control. This study assessed the impact of selection bias in a large cluster-randomized controlled trial. Methods The Improved Cardiovascular Risk Reduction to Enhance Rural Primary Care (ICARE study examined the impact of a remote pharmacist-led intervention in twelve medical offices. To assess eligibility, a standardized form containing patient demographics and medical information was completed for each screened patient. Eligible patients were approached by the study coordinator for recruitment. Both the study coordinator and the patient were aware of the site’s allocation prior to consent. Patients who consented or declined to participate were compared across control and intervention arms for differing characteristics. Statistical significance was determined using a two-tailed, equal variance t-test and a chi-square test with adjusted Bonferroni p-values. Results were adjusted for random cluster variation. Results There were 2749 completed screening forms returned to research staff with 461 subjects who had either consented or declined participation. Patients with poorly controlled diabetes were found to be significantly more likely to decline participation in intervention sites compared to those in control sites. A higher mean diastolic blood pressure was seen in patients with uncontrolled hypertension who declined in the control sites compared to those who declined in the intervention sites. However, these findings were no longer significant after adjustment for random variation among the sites. After this adjustment, females were now found to be significantly more likely to consent than males (odds ratio = 1.41; 95% confidence interval = 1.03, 1

  14. Randomized trial of switching from prescribed non-selective non-steroidal anti-inflammatory drugs to prescribed celecoxib

    DEFF Research Database (Denmark)

    Macdonald, Thomas M; Hawkey, Chris J; Ford, Ian

    2017-01-01

    BACKGROUND: Selective cyclooxygenase-2 inhibitors and conventional non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs) have been associated with adverse cardiovascular (CV) effects. We compared the CV safety of switching to celecoxib vs. continuing nsNSAID therapy in a European setting....... METHOD: Patients aged 60 years and over with osteoarthritis or rheumatoid arthritis, free from established CV disease and taking chronic prescribed nsNSAIDs, were randomized to switch to celecoxib or to continue their previous nsNSAID. The primary endpoint was hospitalization for non-fatal myocardial...... expected developed an on-treatment (OT) primary CV event and the rate was similar for celecoxib, 0.95 per 100 patient-years, and nsNSAIDs, 0.86 per 100 patient-years (HR = 1.12, 95% confidence interval, 0.81-1.55; P = 0.50). Comparable intention-to-treat (ITT) rates were 1.14 per 100 patient...

  15. Vancomycin gene selection in the microbiome of urban Rattus norvegicus from hospital environment

    DEFF Research Database (Denmark)

    Arn Hansen, Thomas; Joshi, Tejal; Larsen, Anders Rhod

    2016-01-01

    Widespread use of antibiotics has resulted in selection pressure on genes that make bacteria non-responsive to antibiotics. These antibiotic-resistant bacteria are currently a major threat to global health. There are various possibilities for the transfer of antibiotic resistance genes. It has be....... norvegicus microbiome, potentially driven by the outflow of antibiotics and antibiotic-resistant bacteria into the wastewater systems. Carriage of vancomycin resistance may suggest that R. norvegicus is acting as a reservoir for possible transmission to the human population....... argued that animal vectors such as Rattus norvegicus (R. norvegicus) living in hospital sewage systems are ideal for carrying pathogens responsible for fatal diseases in humans. Using a metagenomic sequencing approach, we investigated faecal samples of R. norvegicus from three major cities...

  16. [Smoking among patients of selected specialist clinics of Miedzylesie Specialist Hospital in Warsaw].

    Science.gov (United States)

    Pytka, Dorota; Doboszyńska, Anna

    2011-01-01

    The purpose of the study is to examine the issue of smoking among patients of selected clinics of the Miedzylesie Specialist Hospital in Warsaw, assessment of nicotine addiction of smokers and motivation to give up smoking. The survey was carried out in June and July 2009 after obtaining the consent of the Director of Miedzylesie Specialist Hospital in Warsaw. The survey was participated in by 100 patients of selected specialist clinics. The survey was carried out on the basis of a questionnaire consisting of 7 questions. Furthermore, the "Test of motivation to give up smoking" (Schneider's test) and the "Assessment of nicotine addiction level" (Fagerström's test), published in the "Consensus regarding recognition and treatment of nicotine addiction", were used. When processing data, the descriptive statistics were applied. Those surveyed included 53 former cigarette smokers 47 active smokers and. In the group of former smokers, 19 people still were exposed to passive smoking. In the past, the problem regarded 41 people. Thirty former smokers smoked cigarettes among non-smokers, including young children (18 people) and when pregnant and breastfeeding (2 people). Also 30 respondents smoked despite medical contraindications and bad conscience. For 27 people, expenditures on cigarettes constituted a considerable burden of their respective household budgets, and 20 said that it was a significant item in their expenditures. Smokers have been smoking cigarettes for 30 years, on average 20 cigarettes a day. Those patients began to smoke at the age of 20. Thirty one active smokers exposed other people to passive smoking and 38 respondents smoked cigarettes despite medical contraindications and with bad conscience. For 22 people, expenditures related to smoking are a considerable burden of the household budget and for 21 people, it is a significant expenditure. Almost one half of the patients smoke cigarettes although they should brake off smoking for medical reasons. Most

  17. Effect of non-random mating on genomic and BLUP selection schemes

    Directory of Open Access Journals (Sweden)

    Nirea Kahsay G

    2012-04-01

    Full Text Available Abstract Background The risk of long-term unequal contribution of mating pairs to the gene pool is that deleterious recessive genes can be expressed. Such consequences could be alleviated by appropriately designing and optimizing breeding schemes i.e. by improving selection and mating procedures. Methods We studied the effect of mating designs, random, minimum coancestry and minimum covariance of ancestral contributions on rate of inbreeding and genetic gain for schemes with different information sources, i.e. sib test or own performance records, different genetic evaluation methods, i.e. BLUP or genomic selection, and different family structures, i.e. factorial or pair-wise. Results Results showed that substantial differences in rates of inbreeding due to mating design were present under schemes with a pair-wise family structure, for which minimum coancestry turned out to be more effective to generate lower rates of inbreeding. Specifically, substantial reductions in rates of inbreeding were observed in schemes using sib test records and BLUP evaluation. However, with a factorial family structure, differences in rates of inbreeding due mating designs were minor. Moreover, non-random mating had only a small effect in breeding schemes that used genomic evaluation, regardless of the information source. Conclusions It was concluded that minimum coancestry remains an efficient mating design when BLUP is used for genetic evaluation or when the size of the population is small, whereas the effect of non-random mating is smaller in schemes using genomic evaluation.

  18. A randomized controlled trial of a home hospital intervention for frail elderly demented patients: behavioral disturbances and caregiver's stress.

    Science.gov (United States)

    Tibaldi, V; Aimonino, N; Ponzetto, M; Stasi, M F; Amati, D; Raspo, S; Roglia, D; Molaschi, M; Fabris, F

    2004-01-01

    A Geriatric Home Hospitalization Service (GHHS) has been operating in Torino at S. Giovanni Battista Hospital since 1985. GHHS allows us to perform diagnostic and therapeutic interventions, which are usually made in hospital, also at home. GHHS team includes geriatricians, nurses, physiotherapists, social workers and counselors. Between February 1999 and April 2002, the GHH Service conducted a randomized controlled trial on 109 elderly, demented patients requiring admission to the Hospital Emergency Department (ED)for acute illnesses. Objective of the study was to identify the benefits of the care in a GHHScompared to a general medical ward (GMW) in reducing behavioral disturbances in elderly patients with advanced dementia and in lowering caregiver's stress. Patients were randomly assigned to GHHS (56 patients) or to GMW (53 patients). Both groups were examined using the same protocol and were evaluated on admission and on discharge. All patients had a severe form of dementia as shown by the clinical dementia rating (CDR) scale mean value (3.7 +/- 0.9) with an important functional impairment and a relevant degree of comorbidity.The main reasons for hospitalization were infections, cerebrovascular accidents and malnutrition. Mortality of total sample was 19.3 %, without significant differences in the two settings of care. On discharge, in GHHS patients there was a significant reduction of behavioral disturbances. The use of anti-psychotic drugs was significantly lower in GHHS patients compared to the GMW group (p < 0.001). The stress of caregivers on discharge was reduced only in GHHS group and not in the control ones. In conclusion, we can say that a GHHS continuous support allows us to reduce the family caregiver's stress. When treated at home, demented patients do not have to change their environment or routine and it is possible to have a better control on behavioral disturbances.

  19. Emulsion PCR: a high efficient way of PCR amplification of random DNA libraries in aptamer selection.

    Directory of Open Access Journals (Sweden)

    Keke Shao

    Full Text Available Aptamers are short RNA or DNA oligonucleotides which can bind with different targets. Typically, they are selected from a large number of random DNA sequence libraries. The main strategy to obtain aptamers is systematic evolution of ligands by exponential enrichment (SELEX. Low efficiency is one of the limitations for conventional PCR amplification of random DNA sequence library in aptamer selection because of relative low products and high by-products formation efficiency. Here, we developed emulsion PCR for aptamer selection. With this method, the by-products formation decreased tremendously to an undetectable level, while the products formation increased significantly. Our results indicated that by-products in conventional PCR amplification were from primer-product and product-product hybridization. In emulsion PCR, we can completely avoid the product-product hybridization and avoid the most of primer-product hybridization if the conditions were optimized. In addition, it also showed that the molecule ratio of template to compartment was crucial to by-product formation efficiency in emulsion PCR amplification. Furthermore, the concentration of the Taq DNA polymerase in the emulsion PCR mixture had a significant impact on product formation efficiency. So, the results of our study indicated that emulsion PCR could improve the efficiency of SELEX.

  20. A randomized controlled trial of hospital versus home based therapy with oral amoxicillin for severe pneumonia in children aged 3 - 59 months: The IndiaCLEN Severe Pneumonia Oral Therapy (ISPOT) Study

    National Research Council Canada - National Science Library

    Patel, Archana B; Bang, Akash; Singh, Meenu; Dhande, Leena; Chelliah, Luke Ravi; Malik, Ashraf; Khadse, Sandhya

    2015-01-01

    ... with the first 48 h of treatment given in the hospital (hospital group) or at home (home group). We conducted an open-label, multi-center, two-arm randomized clinical trial at six tertiary hospitals in India...

  1. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael

    2013-01-01

    . Documentation exists in; well-being of patients and staff, sleep disorders, pain distraction, confidentiality and privacy, levels of errors in hospitals. Art and the use of color: Art can be context related so one should be aware whether it is in a private ward or the foyer and related to the experience...... in treating disease can be supported by architecture which is sensitive to the contextual conditions of healing in health facilities. It is not the intention to supplant technology, but a question of supplementing the incredible advances that have been made in medicine in recent decades. The central premise......- sick-leave and work-related injuries....

  2. Procalcitonin guided antibiotic therapy and hospitalization in patients with lower respiratory tract infections: a prospective, multicenter, randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Henzen Christoph

    2007-07-01

    Full Text Available Abstract Background: Lower respiratory tract infections like acute bronchitis, exacerbated chronic obstructive pulmonary disease and community-acquired pneumonia are often unnecessarily treated with antibiotics, mainly because of physicians' difficulties to distinguish viral from bacterial cause and to estimate disease-severity. The goal of this trial is to compare medical outcomes, use of antibiotics and hospital resources in a strategy based on enforced evidence-based guidelines versus procalcitonin guided antibiotic therapy in patients with lower respiratory tract infections. Methods and design: We describe a prospective randomized controlled non-inferiority trial with an open intervention. We aim to randomize over a fixed recruitment period of 18 months a minimal number of 1002 patients from 6 hospitals in Switzerland. Patients must be >18 years of age with a lower respiratory tract infections Discussion: Use of and prolonged exposure to antibiotics in lower respiratory tract infections is high. The proposed trial investigates whether procalcitonin-guidance may safely reduce antibiotic consumption along with reductions in hospitalization costs and antibiotic resistance. It will additionally generate insights for improved prognostic assessment of patients with lower respiratory tract infections. Trial registration: ISRCTN95122877

  3. Rationale and design of the MASS COMM trial: A randomized trial to compare percutaneous coronary intervention between MASSachusetts hospitals with cardiac surgery on-site and COMMunity hospitals without cardiac surgery on-site.

    Science.gov (United States)

    Mauri, Laura; Normand, Sharon-Lise T; Pencina, Michael; Cutlip, Donald E; Jeon, Cathy; Dreyer, Paul; Kuntz, Richard E; Baim, Donald S; Jacobs, Alice K

    2011-11-01

    Emergency surgery has become an increasingly rare event after percutaneous coronary intervention (PCI). There have been no randomized trials evaluating whether cardiac surgery services on-site are essential for patient safety and optimal outcomes during and after PCI. The MASS COMM trial (ClinicalTrials.gov no. NCT01116882) is a randomized trial comparing the safety and effectiveness of nonemergency PCI at hospitals without surgery on-site (SOS) (non-SOS hospitals) and hospitals with SOS (SOS hospitals). A total of 3,690 subjects will be randomized in a 3:1 fashion to undergo PCI at non-SOS and SOS hospitals, with follow-up at hospital discharge, 30 days, and 12 months after PCI. The rate of major adverse cardiac events (all-cause mortality, myocardial infarction, repeat revascularization, and stroke) will serve as the primary safety end point at 30 days and the primary effectiveness end point at 12 months. The design is a 1-way randomized trial with a statistical hypothesis of noninferiority of nonemergency PCI at non-SOS hospitals for both safety and effectiveness end points. This multicenter, randomized trial will compare the relative safety and effectiveness of nonemergency PCI at sites with and without cardiac SOS. Copyright © 2011 Mosby, Inc. All rights reserved.

  4. Novel Zn2+-chelating peptides selected from a fimbria-displayed random peptide library

    DEFF Research Database (Denmark)

    Kjærgaard, Kristian; Schembri, Mark; Klemm, Per

    2001-01-01

    H adhesin. FimH is a component of the fimbrial organelle that can accommodate and display a diverse range of peptide sequences on the E. coli cell surface. In this study we have constructed a random peptide library in FimH. The library, consisting of similar to 40 million individual clones, was screened...... for peptide sequences that conferred on recombinant cells the ability to bind Zn2+. By serial selection, sequences that exhibited various degrees of binding affinity and specificity toward Zn2+ were enriched. None of the isolated sequences showed similarity to known Zn2+-binding proteins, indicating...

  5. Alcohol brief intervention for hospitalized veterans with hazardous drinking: protocol for a 3-arm randomized controlled efficacy trial.

    Science.gov (United States)

    Broyles, Lauren M; Wieland, Melissa E; Confer, Andrea L; DiNardo, Monica M; Kraemer, Kevin L; Hanusa, Barbara H; Youk, Ada O; Gordon, Adam J; Sevick, Mary Ann

    2015-05-13

    Various hospital accreditation and quality assurance entities in the United States have approved and endorsed performance measures promoting alcohol brief intervention (BI) for hospitalized individuals who screen positive for unhealthy alcohol use, the spectrum of use ranging from hazardous use to alcohol use disorders. These performance measures have been controversial due to the limited and equivocal evidence for the efficacy of BI among hospitalized individuals. The few BI trials conducted with hospital inpatients vary widely in methodological quality. While the majority of these studies indicate limited to no effects of BI in this population, none have been designed to account for the most pervasive methodological issue in BI studies presumed to drive study findings towards the null: assessment reactivity (AR). This is a three-arm, single-site, randomized controlled trial of BI for hospitalized patients at a large academic medical center affiliated with the U.S. Department of Veterans Affairs who use alcohol at hazardous levels but do not have an alcohol use disorder. Participants are randomized to one of three study conditions. Study Arm 1 receives a three-part alcohol BI. Study Arm 2 receives attention control. To account for potential AR, Study Arm 3 receives AC with limited assessment. Primary outcomes will include the number of standard drinks/week and binge drinking episodes reported in the 30-day period prior to a final measurement visit obtained 6 months after hospital discharge. Additional outcomes will include readiness to change drinking behavior and number of adverse consequences of alcohol use. To assess differences in primary outcomes across the three arms, we will use mixed-effects regression models that account for a patient's repeated measures over the timepoints and clustering within medical units. Intervention implementation will be assessed by: a) review of intervention audio recordings to characterize barriers to intervention fidelity; and

  6. Protein-enriched familiar foods and drinks improve protein intake of hospitalized older patients: A randomized controlled trial.

    Science.gov (United States)

    Beelen, Janne; Vasse, Emmelyne; Janssen, Nancy; Janse, André; de Roos, Nicole M; de Groot, Lisette C P G M

    2017-05-18

    Adequate protein intake is important in preventing and treating undernutrition. Hospitalized older patients are recommended to consume 1.2-1.5 g of protein per kg body weight per day (g/kg/d) but most of them fail to do so. Therefore, we investigated whether a range of newly developed protein-enriched familiar foods and drinks were effective in increasing protein intake of hospitalized older patients. This randomized controlled trial involved 147 patients of ≥65 years (mean age: 78.5 ± 7.4 years). The control group (n = 80) received the standard energy and protein rich hospital menu. The intervention group (n = 67) received the same menu with various protein-enriched intervention products replacing regular products or added to the menu. Macronutrient intake on the fourth day of hospitalization, based on food ordering data, was compared between the two groups by using Independent T-tests and Mann Whitney U-tests. In the intervention group 30% of total protein was provided by the intervention products. The intervention group consumed 105.7 ± 34.2 g protein compared to 88.2 ± 24.4 g in the control group (p protein intake of 1.2 g/kg/d (79.1% vs 47.5%). Protein intake was significantly higher in the intervention group at breakfast, during the morning between breakfast and lunch, and at dinner. This study shows that providing protein-enriched familiar foods and drinks, as replacement of regular products or as additions to the hospital menu, better enables hospitalized older patients to reach protein intake recommendations. This trial is registered on ClinicalTrials.gov, Identifier: NCT02213393. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  7. Assessing the accuracy and stability of variable selection methods for random forest modeling in ecology.

    Science.gov (United States)

    Fox, Eric W; Hill, Ryan A; Leibowitz, Scott G; Olsen, Anthony R; Thornbrugh, Darren J; Weber, Marc H

    2017-07-01

    Random forest (RF) modeling has emerged as an important statistical learning method in ecology due to its exceptional predictive performance. However, for large and complex ecological data sets, there is limited guidance on variable selection methods for RF modeling. Typically, either a preselected set of predictor variables are used or stepwise procedures are employed which iteratively remove variables according to their importance measures. This paper investigates the application of variable selection methods to RF models for predicting probable biological stream condition. Our motivating data set consists of the good/poor condition of n = 1365 stream survey sites from the 2008/2009 National Rivers and Stream Assessment, and a large set (p = 212) of landscape features from the StreamCat data set as potential predictors. We compare two types of RF models: a full variable set model with all 212 predictors and a reduced variable set model selected using a backward elimination approach. We assess model accuracy using RF's internal out-of-bag estimate, and a cross-validation procedure with validation folds external to the variable selection process. We also assess the stability of the spatial predictions generated by the RF models to changes in the number of predictors and argue that model selection needs to consider both accuracy and stability. The results suggest that RF modeling is robust to the inclusion of many variables of moderate to low importance. We found no substantial improvement in cross-validated accuracy as a result of variable reduction. Moreover, the backward elimination procedure tended to select too few variables and exhibited numerous issues such as upwardly biased out-of-bag accuracy estimates and instabilities in the spatial predictions. We use simulations to further support and generalize results from the analysis of real data. A main purpose of this work is to elucidate issues of model selection bias and instability to ecologists interested in

  8. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.

    Science.gov (United States)

    Lorig, K R; Sobel, D S; Stewart, A L; Brown, B W; Bandura, A; Ritter, P; Gonzalez, V M; Laurent, D D; Holman, H R

    1999-01-01

    This study evaluated the effectiveness (changes in health behaviors, health status, and health service utilization) of a self-management program for chronic disease designed for use with a heterogeneous group of chronic disease patients. It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities. The study was a six-month randomized, controlled trial at community-based sites comparing treatment subjects with wait-list control subjects. Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease, lung disease, stroke, or arthritis. Health behaviors, health status, and health service utilization, as determined by mailed, self-administered questionnaires, were measured. Treatment subjects, when compared with control subjects, demonstrated improvements at 6 months in weekly minutes of exercise, frequency of cognitive symptom management, communication with physicians, self-reported health, health distress, fatigue, disability, and social/role activities limitations. They also had fewer hospitalizations and days in the hospital. No differences were found in pain/physical discomfort, shortness of breath, or psychological well-being. An intervention designed specifically to meet the needs of a heterogeneous group of chronic disease patients, including those with comorbid conditions, was feasible and beneficial beyond usual care in terms of improved health behaviors and health status. It also resulted in fewer hospitalizations and days of hospitalization.

  9. Effect of a multidisciplinary program for the prevention of low back pain in hospital employees: a randomized controlled trial.

    Science.gov (United States)

    Roussel, Nathalie A; Kos, Daphne; Demeure, Isaline; Heyrman, Annette; De Clerck, Marleen; Zinzen, Evert; Struyf, Filip; Nijs, Jo

    2015-01-01

    Hospital workers with physically demanding jobs are at risk for developing recurrent LBP. There is a lack of studies evaluating multidisciplinary prevention of low back pain (LBP) in hospital workers. This randomized controlled trial evaluates the effect of a multidisciplinary prevention program, focusing on a client-centred approach, on hospital workers at risk for developing LBP. Caregiving hospital workers were allocated to an experimental (12-week lasting multidisciplinary prevention program) or control group (no intervention). They were evaluated prior to the intervention and after a 6 months follow-up period. Primary outcome measures included incidence of LBP, work absenteeism and general health. Secondary outcomes included daily physical activity, job satisfaction and coping strategies. A significant improvement was seen for passive coping after 6 months follow-up, but no significant differences were observed between groups in primary or other secondary outcome measures (p> 0.05). A multidisciplinary prevention program fitting into a bio-psychosocial context may not have been intensive enough to promote a change in daily habitudes, and had no effect on work absenteeism, incidence of LBP or general health. Further research should determine whether prevention of LBP is possible in caregiving personnel.

  10. Functional form and risk adjustment of hospital costs: Bayesian analysis of a Box-Cox random coefficients model.

    Science.gov (United States)

    Hollenbeak, Christopher S

    2005-10-15

    While risk-adjusted outcomes are often used to compare the performance of hospitals and physicians, the most appropriate functional form for the risk adjustment process is not always obvious for continuous outcomes such as costs. Semi-log models are used most often to correct skewness in cost data, but there has been limited research to determine whether the log transformation is sufficient or whether another transformation is more appropriate. This study explores the most appropriate functional form for risk-adjusting the cost of coronary artery bypass graft (CABG) surgery. Data included patients undergoing CABG surgery at four hospitals in the midwest and were fit to a Box-Cox model with random coefficients (BCRC) using Markov chain Monte Carlo methods. Marginal likelihoods and Bayes factors were computed to perform model comparison of alternative model specifications. Rankings of hospital performance were created from the simulation output and the rankings produced by Bayesian estimates were compared to rankings produced by standard models fit using classical methods. Results suggest that, for these data, the most appropriate functional form is not logarithmic, but corresponds to a Box-Cox transformation of -1. Furthermore, Bayes factors overwhelmingly rejected the natural log transformation. However, the hospital ranking induced by the BCRC model was not different from the ranking produced by maximum likelihood estimates of either the linear or semi-log model. Copyright (c) 2005 John Wiley & Sons, Ltd.

  11. PReFerSim: fast simulation of demography and selection under the Poisson Random Field model.

    Science.gov (United States)

    Ortega-Del Vecchyo, Diego; Marsden, Clare D; Lohmueller, Kirk E

    2016-11-15

    The Poisson Random Field (PRF) model has become an important tool in population genetics to study weakly deleterious genetic variation under complicated demographic scenarios. Currently, there are no freely available software applications that allow simulation of genetic variation data under this model. Here we present PReFerSim, an ANSI C program that performs forward simulations under the PRF model. PReFerSim models changes in population size, arbitrary amounts of inbreeding, dominance and distributions of selective effects. Users can track summaries of genetic variation over time and output trajectories of selected alleles. PReFerSim is freely available at: https://github.com/LohmuellerLab/PReFerSim CONTACT: klohmueller@ucla.eduSupplementary information: Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  12. HELP! Problems in executing a pragmatic, randomized, stepped wedge trial on the Hospital Elder Life Program to prevent delirium in older patients.

    Science.gov (United States)

    Heim, Noor; van Stel, Henk F; Ettema, Roelof G; van der Mast, Roos C; Inouye, Sharon K; Schuurmans, Marieke J

    2017-05-17

    A pragmatic, stepped wedge trial design can be an appealing design to evaluate complex interventions in real-life settings. However, there are certain pitfalls that need to be considered. This paper reports on the experiences and lessons learned from the conduct of a cluster randomized, stepped wedge trial evaluating the effect of the Hospital Elder Life Program (HELP) in a Dutch hospital setting to prevent older patients from developing delirium. We evaluated our trial which was conducted in eight departments in two hospitals in hospitalized patients aged 70 years or older who were at risk for delirium by reflecting on the assumptions that we had and on what we intended to accomplish when we started, as compared to what we actually realized in the different phases of our study. Lessons learned on the design, the timeline, the enrollment of eligible patients and the use of routinely collected data are provided accompanied by recommendations to address challenges. The start of the trial was delayed which caused subsequent time schedule problems. The requirement for individual informed consent for a quality improvement project made the inclusion more prone to selection bias. Most units experienced major difficulties in including patients, leading to excluding two of the eight units from participation. This resulted in failing to include a similar number of patients in the control condition versus the intervention condition. Data on outcomes routinely collected in the electronic patient records were not accessible during the study, and appeared to be often missing during analyses. The stepped wedge, cluster randomized trial poses specific risks in the design and execution of research in real-life settings of which researchers should be aware to prevent negative consequences impacting the validity of their results. Valid conclusions on the effectiveness of the HELP in the Dutch hospital setting are hampered by the limited quantity and quality of routine clinical data

  13. The medicine selection process in four large university hospitals in Brazil: Does the DTC have a role?

    Directory of Open Access Journals (Sweden)

    Elisangela da Costa Lima-Dellamora

    2015-03-01

    Full Text Available Knowledge about evidence-based medicine selection and the role of the Drug and Therapeutics Committee (DTC is an important topic in the literature but is scarcely discussed in Brazil. Our objective, using a qualitative design, was to analyze the medicine selection process performed in four large university hospitals in the state of Rio de Janeiro. Information was collected from documents, interviews with key informants and direct observations. Two dimensions were analyzed: the structural and organizational aspects of the selection process and the criteria and methods used in medicine selection. The findings showed that the DTC was active in two hospitals. The structure for decision-making was weak. DTC members had little experience in evidence-based selection, and their everyday functions did not influence their participation in DTC activities. The methods used to evaluate evidence were inadequate. The uncritical adoption of new medicines in these complex hospital facilities may be hampering pharmaceutical services, with consequences for the entire health system. Although the qualitative approach considerably limits the extent to which the results can be extrapolated, we believe that our findings may be relevant to other university hospitals in the country.

  14. The impact of chaplaincy services in selected hospitals in the eastern United States.

    Science.gov (United States)

    Parkum, K H

    1985-09-01

    Surveys a stratified sample of patients in six different hospitals and compares their perceptions of hospital chaplaincy and other pastoral care efforts with related hospital services. Reports the presence of a strong impact of pastoral care services and discusses these findings from the perspective of a theory of expressive and instrumental social orientations as explicated by the sociologist Talcott Parsons.

  15. Ethnopharmacological versus random plant selection methods for the evaluation of the antimycobacterial activity

    Directory of Open Access Journals (Sweden)

    Danilo R. Oliveira

    2011-05-01

    Full Text Available The municipality of Oriximiná, Brazil, has 33 quilombola communities in remote areas, endowed with wide experience in the use of medicinal plants. An ethnobotanical survey was carried out in five of these communities. A free-listing method directed for the survey of species locally indicated against Tuberculosis and lung problems was also applied. Data were analyzed by quantitative techniques: saliency index and major use agreement. Thirty four informants related 254 ethnospecies. Among these, 43 were surveyed for possible antimycobacterial activity. As a result of those informations, ten species obtained from the ethnodirected approach (ETHNO and eighteen species obtained from the random approach (RANDOM were assayed against Mycobacterium tuberculosis by the microdilution method, using resazurin as an indicator of cell viability. The best results for antimycobacterial activity were obtained of some plants selected by the ethnopharmacological approach (50% ETHNO x 16,7% RANDOM. These results can be even more significant if we consider that the therapeutic success obtained among the quilombola practice is complex, being the use of some plants acting as fortifying agents, depurative, vomitory, purgative and bitter remedy, especially to infectious diseases, of great importance to the communities in the curing or recovering of health as a whole.

  16. Random forest variable selection in spatial malaria transmission modelling in Mpumalanga Province, South Africa.

    Science.gov (United States)

    Kapwata, Thandi; Gebreslasie, Michael T

    2016-11-16

    Malaria is an environmentally driven disease. In order to quantify the spatial variability of malaria transmission, it is imperative to understand the interactions between environmental variables and malaria epidemiology at a micro-geographic level using a novel statistical approach. The random forest (RF) statistical learning method, a relatively new variable-importance ranking method, measures the variable importance of potentially influential parameters through the percent increase of the mean squared error. As this value increases, so does the relative importance of the associated variable. The principal aim of this study was to create predictive malaria maps generated using the selected variables based on the RF algorithm in the Ehlanzeni District of Mpumalanga Province, South Africa. From the seven environmental variables used [temperature, lag temperature, rainfall, lag rainfall, humidity, altitude, and the normalized difference vegetation index (NDVI)], altitude was identified as the most influential predictor variable due its high selection frequency. It was selected as the top predictor for 4 out of 12 months of the year, followed by NDVI, temperature and lag rainfall, which were each selected twice. The combination of climatic variables that produced the highest prediction accuracy was altitude, NDVI, and temperature. This suggests that these three variables have high predictive capabilities in relation to malaria transmission. Furthermore, it is anticipated that the predictive maps generated from predictions made by the RF algorithm could be used to monitor the progression of malaria and assist in intervention and prevention efforts with respect to malaria.

  17. Random forest variable selection in spatial malaria transmission modelling in Mpumalanga Province, South Africa

    Directory of Open Access Journals (Sweden)

    Thandi Kapwata

    2016-11-01

    Full Text Available Malaria is an environmentally driven disease. In order to quantify the spatial variability of malaria transmission, it is imperative to understand the interactions between environmental variables and malaria epidemiology at a micro-geographic level using a novel statistical approach. The random forest (RF statistical learning method, a relatively new variable-importance ranking method, measures the variable importance of potentially influential parameters through the percent increase of the mean squared error. As this value increases, so does the relative importance of the associated variable. The principal aim of this study was to create predictive malaria maps generated using the selected variables based on the RF algorithm in the Ehlanzeni District of Mpumalanga Province, South Africa. From the seven environmental variables used [temperature, lag temperature, rainfall, lag rainfall, humidity, altitude, and the normalized difference vegetation index (NDVI], altitude was identified as the most influential predictor variable due its high selection frequency. It was selected as the top predictor for 4 out of 12 months of the year, followed by NDVI, temperature and lag rainfall, which were each selected twice. The combination of climatic variables that produced the highest prediction accuracy was altitude, NDVI, and temperature. This suggests that these three variables have high predictive capabilities in relation to malaria transmission. Furthermore, it is anticipated that the predictive maps generated from predictions made by the RF algorithm could be used to monitor the progression of malaria and assist in intervention and prevention efforts with respect to malaria.

  18. Selecting the appropriate pacing mode for patients with sick sinus syndrome: evidence from randomized clinical trials.

    Science.gov (United States)

    Albertsen, A E; Nielsen, J C

    2003-12-01

    Several observational studies have indicated that selection of pacing mode may be important for the clinical outcome in patients with symptomatic bradycardia, affecting the development of atrial fibrillation (AF), thromboembolism, congestive heart failure, mortality and quality of life. In this paper we present and discuss the most recent data from six randomized trials on mode selection in patients with sick sinus syndrome (SSS). In pacing mode selection, VVI(R) pacing is the least attractive solution, increasing the incidence of AF and-as compared with AAI(R) pacing, also the incidence of heart failure, thromboembolism and death. VVI(R) pacing should not be used as the primary pacing mode in patients with SSS, who haven't chronic AF. AAIR pacing is superior to DDDR pacing, reducing AF and preserving left ventricular function. Single site right ventricular pacing-VVI(R) or DDD(R) mode-causes an abnormal ventricular activation and contraction (called ventricular desynchronization), which results in a reduced left ventricular function. Despite the risk of AV block, we consider AAIR pacing to be the optimal pacing mode for isolated SSS today and an algorithm to select patients for AAIR pacing is suggested. Trials on new pacemaker algorithms minimizing right ventricular pacing as well as trials testing alternative pacing sites and multisite pacing to reduce ventricular desynchronization can be expected within the next years.

  19. Geography and genography: prediction of continental origin using randomly selected single nucleotide polymorphisms

    Directory of Open Access Journals (Sweden)

    Ramoni Marco F

    2007-03-01

    Full Text Available Abstract Background Recent studies have shown that when individuals are grouped on the basis of genetic similarity, group membership corresponds closely to continental origin. There has been considerable debate about the implications of these findings in the context of larger debates about race and the extent of genetic variation between groups. Some have argued that clustering according to continental origin demonstrates the existence of significant genetic differences between groups and that these differences may have important implications for differences in health and disease. Others argue that clustering according to continental origin requires the use of large amounts of genetic data or specifically chosen markers and is indicative only of very subtle genetic differences that are unlikely to have biomedical significance. Results We used small numbers of randomly selected single nucleotide polymorphisms (SNPs from the International HapMap Project to train naïve Bayes classifiers for prediction of ancestral continent of origin. Predictive accuracy was tested on two independent data sets. Genetically similar groups should be difficult to distinguish, especially if only a small number of genetic markers are used. The genetic differences between continentally defined groups are sufficiently large that one can accurately predict ancestral continent of origin using only a minute, randomly selected fraction of the genetic variation present in the human genome. Genotype data from only 50 random SNPs was sufficient to predict ancestral continent of origin in our primary test data set with an average accuracy of 95%. Genetic variations informative about ancestry were common and widely distributed throughout the genome. Conclusion Accurate characterization of ancestry is possible using small numbers of randomly selected SNPs. The results presented here show how investigators conducting genetic association studies can use small numbers of arbitrarily

  20. Joint random beam and spectrum selection for spectrum sharing systems with partial channel state information

    KAUST Repository

    Abdallah, Mohamed M.

    2013-11-01

    In this work, we develop joint interference-aware random beam and spectrum selection scheme that provide enhanced performance for the secondary network under the condition that the interference observed at the primary receiver is below a predetermined acceptable value. We consider a secondary link composed of a transmitter equipped with multiple antennas and a single-antenna receiver sharing the same spectrum with a set of primary links composed of a single-antenna transmitter and a single-antenna receiver. The proposed schemes jointly select a beam, among a set of power-optimized random beams, as well as the primary spectrum that maximizes the signal-to-interference-plus-noise ratio (SINR) of the secondary link while satisfying the primary interference constraint. In particular, we consider the case where the interference level is described by a q-bit description of its magnitude, whereby we propose a technique to find the optimal quantizer thresholds in a mean square error (MSE) sense. © 2013 IEEE.

  1. Interference-aware random beam selection schemes for spectrum sharing systems

    KAUST Repository

    Abdallah, Mohamed

    2012-10-19

    Spectrum sharing systems have been recently introduced to alleviate the problem of spectrum scarcity by allowing secondary unlicensed networks to share the spectrum with primary licensed networks under acceptable interference levels to the primary users. In this work, we develop interference-aware random beam selection schemes that provide enhanced performance for the secondary network under the condition that the interference observed by the receivers of the primary network is below a predetermined/acceptable value. We consider a secondary link composed of a transmitter equipped with multiple antennas and a single-antenna receiver sharing the same spectrum with a primary link composed of a single-antenna transmitter and a single-antenna receiver. The proposed schemes select a beam, among a set of power-optimized random beams, that maximizes the signal-to-interference-plus-noise ratio (SINR) of the secondary link while satisfying the primary interference constraint for different levels of feedback information describing the interference level at the primary receiver. For the proposed schemes, we develop a statistical analysis for the SINR statistics as well as the capacity and bit error rate (BER) of the secondary link.

  2. Feature selection for outcome prediction in oesophageal cancer using genetic algorithm and random forest classifier.

    Science.gov (United States)

    Paul, Desbordes; Su, Ruan; Romain, Modzelewski; Sébastien, Vauclin; Pierre, Vera; Isabelle, Gardin

    2017-09-01

    The outcome prediction of patients can greatly help to personalize cancer treatment. A large amount of quantitative features (clinical exams, imaging, …) are potentially useful to assess the patient outcome. The challenge is to choose the most predictive subset of features. In this paper, we propose a new feature selection strategy called GARF (genetic algorithm based on random forest) extracted from positron emission tomography (PET) images and clinical data. The most relevant features, predictive of the therapeutic response or which are prognoses of the patient survival 3 years after the end of treatment, were selected using GARF on a cohort of 65 patients with a local advanced oesophageal cancer eligible for chemo-radiation therapy. The most relevant predictive results were obtained with a subset of 9 features leading to a random forest misclassification rate of 18±4% and an areas under the of receiver operating characteristic (ROC) curves (AUC) of 0.823±0.032. The most relevant prognostic results were obtained with 8 features leading to an error rate of 20±7% and an AUC of 0.750±0.108. Both predictive and prognostic results show better performances using GARF than using 4 other studied methods. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Cost effectiveness of patient education for the prevention of falls in hospital: economic evaluation from a randomized controlled trial.

    Science.gov (United States)

    Haines, Terry P; Hill, Anne-Marie; Hill, Keith D; Brauer, Sandra G; Hoffmann, Tammy; Etherton-Beer, Christopher; McPhail, Steven M

    2013-05-22

    Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventing falls in hospitals. Hospital-based falls prevention interventions tested in randomized trials have not yet been subjected to economic evaluation. Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and rehabilitation inpatients. Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research. The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients. The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$14,591 (2008). The education program cost A$526 (2008) to prevent one cognitively intact patient becoming a faller and A$294 (2008) to prevent one fall based on primary trial data. These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial. There was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone. Decision tree modeling sensitivity analyses identified that when provided in real life contexts, the program would be both more effective in preventing falls among cognitively intact inpatients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0%. This economic evaluation was designed to assist

  4. Effect of Nebulized Hypertonic Saline Treatment in Emergency Departments on the Hospitalization Rate for Acute Bronchiolitis: A Randomized Clinical Trial.

    Science.gov (United States)

    Angoulvant, François; Bellêttre, Xavier; Milcent, Karen; Teglas, Jean-Paul; Claudet, Isabelle; Le Guen, Christèle Gras; de Pontual, Loïc; Minodier, Philippe; Dubos, François; Brouard, Jacques; Soussan-Banini, Valérie; Degas-Bussiere, Vanessa; Gatin, Amélie; Schweitzer, Cyril; Epaud, Ralph; Ryckewaert, Amélie; Cros, Pierrick; Marot, Yves; Flahaut, Philippe; Saunier, Pascal; Babe, Philippe; Patteau, Géraldine; Delebarre, Mathilde; Titomanlio, Luigi; Vrignaud, Bénédicte; Trieu, Thanh-Van; Tahir, Abdelilah; Regnard, Delphine; Micheau, Pascale; Charara, Oussama; Henry, Simon; Ploin, Dominique; Panjo, Henri; Vabret, Astrid; Bouyer, Jean; Gajdos, Vincent

    2017-08-07

    Acute bronchiolitis is the leading cause of hospitalization among infants. Previous studies, underpowered to examine hospital admission, have found a limited benefit of nebulized hypertonic saline (HS) treatment in the pediatric emergency department (ED). To examine whether HS nebulization treatment would decrease the hospital admission rate among infants with a first episode of acute bronchiolitis. The Efficacy of 3% Hypertonic Saline in Acute Viral Bronchiolitis (GUERANDE) study was a multicenter, double-blind randomized clinical trial on 2 parallel groups conducted during 2 bronchiolitis seasons (October through March) from October 15, 2012, through April 15, 2014, at 24 French pediatric EDs. Among the 2445 infants (6 weeks to 12 months of age) assessed for inclusion, 777 with a first episode of acute bronchiolitis with respiratory distress and no chronic medical condition were included. Two 20-minute nebulization treatments of 4 mL of HS, 3%, or 4 mL of normal saline (NS), 0.9%, given 20 minutes apart. Hospital admission rate in the 24 hours after enrollment. Of the 777 infants included in the study (median age, 3 months; interquartile range, 2-5 months; 468 [60.2%] male), 385 (49.5%) were randomized to the HS group and 387 (49.8%) to the NS group (5 patients did not receive treatment). By 24 hours, 185 of 385 infants (48.1%) in the HS group were admitted compared with 202 of 387 infants (52.2%) in the NS group. The risk difference for hospitalizations was not significant according to the mixed-effects regression model (adjusted risk difference, -3.2%; 95% CI, -8.7% to 2.2%; P = .25). The mean (SD) Respiratory Distress Assessment Instrument score improvement was greater in the HS group (-3.1 [3.2]) than in the NS group (-2.4 [3.3]) (adjusted difference, -0.7; 95% CI, -1.2 to -0.2; P = .006) and similarly for the Respiratory Assessment Change Score. Mild adverse events, such as worsening of cough, occurred more frequently among children in the HS group

  5. Effects of an Enhanced Discharge Planning Intervention for Hospitalized Older Adults: A Randomized Trial

    Science.gov (United States)

    Altfeld, Susan J.; Shier, Gayle E.; Rooney, Madeleine; Johnson, Tricia J.; Golden, Robyn L.; Karavolos, Kelly; Avery, Elizabeth; Nandi, Vijay; Perry, Anthony J.

    2013-01-01

    Purpose of the Study: To identify needs encountered by older adult patients after hospital discharge and assess the impact of a telephone transitional care intervention on stress, health care utilization, readmissions, and mortality. Design and Methods: Older adult inpatients who met criteria for risk of post-discharge complications were…

  6. Effects of day-hospital rehabilitation in stroke patients : A review of randomized clinical trials

    NARCIS (Netherlands)

    Dekker, R; Drost, EAM; Groothoff, JW; Arendzen, JH; van Gijn, JC; Eisma, WH

    The purpose of this study was to review the literature on the effects of day-hospital rehabilitation (DHR) in stroke patients. In The Netherlands DHR concerns a multidisciplinary approach to decrease disability and handicap and to optimize quality of life in an outpatient setting. Data were

  7. Awareness Of HIV / AIDS Among Hospital Workers | Ugochukwu ...

    African Journals Online (AJOL)

    Objective: To determine the knowledge of a) HIV /AIDS among workers in a teaching Hospital, b) risk of HIV infection among hospital workers and c) precautionary measures against HIV infection in the hospital setting. Methods: 159 randomly selected workers of the Nnamdi Azikiwe University Teaching Hospital Nnewi ...

  8. A Study of Power Relations in Doctor-Patient Interactions in Selected Hospitals in Lagos State, Nigeria

    Science.gov (United States)

    Adam, Qasim

    2014-01-01

    This paper explores power relations in clinical interactions in Nigeria. It seeks to investigate the use of power between doctors and patients during consultations on patient-centred approach to medicine in selected public and private hospitals in Lagos State, Nigeria. The objective is to establish how doctors' projection of power, using the…

  9. Do hospitalized premature infants benefit from music interventions? A systematic review of randomized controlled trials

    NARCIS (Netherlands)

    M.J.E. Van Der Heijden (Marianne J. E.); S.O. Araghi (Sadaf Oliai); J. Jeekel (Hans); I.K.M. Reiss (Irwin); M.G.M. Hunink (Myriam); M. Van Dijk (Monique)

    2016-01-01

    textabstractObjective: Neonatal intensive care units (NICU) around the world increasingly use music interventions. The most recent systematic review of randomized controlled trials (RCT) dates from 2009. Since then, 15 new RCTs have been published. We provide an updated systematic review on the

  10. Implementation of physical activity programs after COPD hospitalizations: Lessons from a randomized study.

    Science.gov (United States)

    Benzo, Roberto; Wetzstein, Marnie; Neuenfeldt, Pamela; McEvoy, Charlene

    2015-02-01

    Pulmonary rehabilitation (PR), following an acute exacerbation of chronic obstructive pulmonary disease (COPD), has been found effective in some studies in reducing readmission rates as and has recently been recommended by the PR guidelines. However, very recent reports suggested that PR is not feasible after a hospital admission for a COPD exacerbation. The objective of this study is to investigate the knowledge gap on the underlying reasons for nonparticipation in PR in the posthospitalization period. We qualitatively analyzed the responses of 531 patients hospitalized for a COPD exacerbation who were not interested in participating in either PR (home or center based) or physical activity monitoring program after being discharged from the hospital. The responses were coded thematically, and independent reviewers compiled the raw data into themes. The characteristics of the 531 subjects (45% male) who declined the intervention are as follows: age was 70 ± 10 years, mean forced expiratory volume in one second (FEV1%) predicted 40 ± 16, and age, dyspnea, and airflow obstruction index 6.0 ± 1.6 (scale 0-10). The themes for not attending include lack of interest (39%), the perception of "being too ill or frail or disabled" (24%), the perception of being "too busy or having too much to do" (11%), distance or the need of travel (11%), commitment issues (7%), comorbidities (6%), and lack of social support (2%). We identified barriers for PR or just physical activity programs after a hospitalization that may affect implementation of such programs. Implementing posthospitalizations program in COPD may require patient engagement and mindful and compassionate professionals who may individualize program components to focus specific deficits and particularly patients' preferences. © The Author(s) 2014.

  11. Physical Activity and Early Rehabilitation in Hospitalized Elderly Medical Patients: Systematic Review of Randomized Clinical Trials.

    Science.gov (United States)

    Martínez-Velilla, N; Cadore, L; Casas-Herrero, Á; Idoate-Saralegui, F; Izquierdo, M

    2016-01-01

    To critically review the effect of interventions incorporating exercise and early rehabilitation (physical therapy, occupational therapy, and physical activity) in the functional outcomes (i.e., active daily living tests, such as Barthel Index Scores, Timed-up-and go, mobility tests), and feasibility in hospitalized elderly medical patients. Systematic review of the literature. A literature search was conducted using the following databases and medical resources from 1966 to January 2014: PubMed (Medline), PEDro, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, Google Scholar, ClinicalTrials.gov, Clinical Evidence, SportsDiscus, EMBASE and UptoDate. Studies must have mentioned the effects of early rehabilitation on the above mentioned functional outcomes and feasibility. Data on the mortality, economic profile and average stay were also described. From the 6564 manuscripts potentially related to exercise performance in hospitalized elderly patients, the review focused on 1086, and 17 articles were ultimately included. Regarding functional outcomes after discharge, four studies observed significant improvement in functional outcomes following early rehabilitation, even up to twelve months after discharge. Eight studies directly or indirectly assessed the economic impact of exercise intervention. Five of them did not show any increase in costs, while three concluded that the intervention was cost effective. No adverse effect related with the interventions were mentioned. The introduction of an exercise program for hospitalized elderly patients may be feasible, and may not increase costs. Importantly, early rehabilitation may also improve the functional and healthcare.

  12. Selection of quality indicators for hospital-based emergency care in Denmark, informed by a modified-Delphi process.

    Science.gov (United States)

    Madsen, Michael Moesmann; Eiset, Andreas Halgreen; Mackenhauer, Julie; Odby, Annette; Christiansen, Christian Fynbo; Kurland, Lisa; Kirkegaard, Hans

    2016-02-03

    In 2013, Danish policy-makers on a nationwide level decided to set up a national quality of care database for hospital-based emergency care in Denmark including the selection of quality indicators. The aim of the study was to describe the Delphi process that contributed to the selection of quality indicators for a new national database of hospital-based emergency care in Denmark. The process comprised a literature review followed by a modified-Delphi survey process, involving a panel of 54 experts (senior clinicians, researchers and administrators from the emergency area and collaborating specialties). Based on the literature review, we identified 43 potential indicators, of which eight were time-critical conditions. We then consulted the Expert panel in two consecutive rounds. The Expert panel was asked to what extent each indicator would be a good measure of hospital-based emergency care in Denmark. In each round, the Expert panel participants scored each indicator on a Likert scale ranging from one (=disagree completely) through to six (=agree completely). Consensus for a quality indicator was reached if the median was greater than or equal to five (=agree). The Delphi process was followed by final selection by the steering group for the new database. Following round two of the Expert panel, consensus was reached on 32 quality indicators, including three time-critical conditions. Subsequently, the database steering group chose a set of nine quality indicators for the initial version of the national database for hospital-based emergency care. The two-round modified Delphi process contributed to the selection of an initial set of nine quality indicators for a new a national database for hospital-based emergency care in Denmark. Final selection was made by the database steering group informed by the Delphi process.

  13. Exercise intervention in childhood obesity: a randomized controlled trial comparing hospital-versus home-based groups.

    Science.gov (United States)

    Lisón, Juan Francisco; Real-Montes, José María; Torró, Isabel; Arguisuelas, María Dolores; Alvarez-Pitti, Julio; Martínez-Gramage, J; Aguilar, Francisco; Lurbe, Empar

    2012-01-01

    The aim of this study was to compare the effect of a hospital clinic group- versus home-based combined exercise-diet program for the treatment of childhood obesity. One hundred ten overweight/obese Spanish children and adolescents (6-16 years) in 2 intervention groups (hospital clinic group-based [n = 45] and home-based [n = 41]) and a sex-age-matched control group (n = 24) were randomly assigned to participate in a 6-month combined exercise (aerobic and resistance training) and Mediterranean diet program. Anthropometric values (including body weight, height, body mass index, BMI-Z score, and waist circumference) were measured pre- and postintervention for all the participants. Percentage body fat was also determined with a body fat analyzer (TANITA TBF-410 M). Our study showed a significant reduction in percentage body fat and body mass index Z-score among both intervention-group participants (4%, 0.16, hospital clinic group-based; 4.4%, 0.23, home-based; P exercise and Mediterranean diet program may be effective among overweight and obese children and adolescents, because it improves body composition, is feasible and can be adopted on a large scale without substantial expenses. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

  14. Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial

    Science.gov (United States)

    2010-01-01

    Background The Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) is a registered, double-blinded, randomized, controlled trial designed to assess the efficacy of osteopathic manipulative treatment (OMT) as an adjunctive treatment in elderly patients with pneumonia. Methods 406 subjects aged ≥ 50 years hospitalized with pneumonia at 7 community hospitals were randomized using concealed allocation to conventional care only (CCO), light-touch treatment (LT), or OMT groups. All subjects received conventional treatment for pneumonia. OMT and LT groups received group-specific protocols for 15 minutes, twice daily until discharge, cessation of antibiotics, respiratory failure, death, or withdrawal from the study. The primary outcomes were hospital length of stay (LOS), time to clinical stability, and a symptomatic and functional recovery score. Results Intention-to-treat (ITT) analysis (n = 387) found no significant differences between groups. Per-protocol (PP) analysis (n = 318) found a significant difference between groups (P = 0.01) in LOS. Multiple comparisons indicated a reduction in median LOS (95% confidence interval) for the OMT group (3.5 [3.2-4.0] days) versus the CCO group (4.5 [3.9-4.9] days), but not versus the LT group (3.9 [3.5-4.8] days). Secondary outcomes of duration of intravenous antibiotics and treatment endpoint were also significantly different between groups (P = 0.05 and 0.006, respectively). Duration of intravenous antibiotics and death or respiratory failure were lower for the OMT group versus the CCO group, but not versus the LT group. Conclusions ITT analysis found no differences between groups. PP analysis found significant reductions in LOS, duration of intravenous antibiotics, and respiratory failure or death when OMT was compared to CCO. Given the prevalence of pneumonia, adjunctive OMT merits further study. PMID:20302619

  15. Does the Use of a Decision Aid Improve Decision Making in Prosthetic Heart Valve Selection? A Multicenter Randomized Trial

    NARCIS (Netherlands)

    Korteland, Nelleke M.; Ahmed, Yunus; Koolbergen, David R.; Brouwer, Marjan; de Heer, Frederiek; Kluin, Jolanda; Bruggemans, Eline F.; Klautz, Robert J. M.; Stiggelbout, Anne M.; Bucx, Jeroen J. J.; Roos-Hesselink, Jolien W.; Polak, Peter; Markou, Thanasie; van den Broek, Inge; Ligthart, Rene; Bogers, Ad J. J. C.; Takkenberg, Johanna J. M.

    2017-01-01

    A Dutch online patient decision aid to support prosthetic heart valve selection was recently developed. A multicenter randomized controlled trial was conducted to assess whether use of the patient decision aid results in optimization of shared decision making in prosthetic heart valve selection. In

  16. The effects of flexed (fetal tucking and extended (free body postures on the daily sleep quantity of hospitalized premature infants: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Leila Valizadeh

    2016-01-01

    Full Text Available Background: Proper sleep is essential for the development of premature infants. Infants, during hospitalization, might suffer from inappropriate postures and insufficient sleep hours. To compare the daily sleep quantities of premature infants in flexed (facilitated fetal tucking posture and extended (free body posture. This study is a randomized clinical trial which was conducted in neonatal ward of Al-Zahra Teaching Hospital of Tabriz, Iran, 2015. Thirty-two premature infants with the age range of 33–36 weeks were selected for the study. Materials and Methods: Every infant was studied for 4 days in a sequential format. Every infant was studied for 4 days and in a 12-h period every day (8 a.m–8 p.m. Each day, an infant was randomly put in one of the four statuses, namely, free body posture in the supine position, free body posture in the lateral position, facilitated fetal tucking in the supine position and facilitated fetal tucking in the lateral position. Films were recorded in the 12-h period (8 a.m–8 p.m. SPSS Software (version 13 was used for data analysis. Results: The results showed that about the main effect of posture on sleep variable, there was a statistically significant difference (P = 0.003. In addition, about the main effect of position on sleep variable; there was a statistically significant difference (P = 0.002. Meanwhile, there was no significant interaction effect between the posture and position for the daily sleep duration (P = 0.746. Daily sleep duration of the infants in flexed (facilitated fetal tucking posture and lateral position is longer than that of the infants in extended (free body posture and supine position. Conclusion: Daily sleep duration in the infants experiencing flexed posture and lateral position at rest is longer. Moreover, it decreases wakefulness time of the premature infants.

  17. Selective outcome reporting and sponsorship in randomized controlled trials in IVF and ICSI.

    Science.gov (United States)

    Braakhekke, M; Scholten, I; Mol, F; Limpens, J; Mol, B W; van der Veen, F

    2017-10-01

    Are randomized controlled trials (RCTs) on IVF and ICSI subject to selective outcome reporting and is this related to sponsorship? There are inconsistencies, independent from sponsorship, in the reporting of primary outcome measures in the majority of IVF and ICSI trials, indicating selective outcome reporting. RCTs are subject to bias at various levels. Of these biases, selective outcome reporting is particularly relevant to IVF and ICSI trials since there is a wide variety of outcome measures to choose from. An established cause of reporting bias is sponsorship. It is, at present, unknown whether RCTs in IVF/ICSI are subject to selective outcome reporting and whether this is related with sponsorship. We systematically searched RCTs on IVF and ICSI published between January 2009 and March 2016 in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the publisher subset of PubMed. We analysed 415 RCTs. Per included RCT, we extracted data on impact factor of the journal, sample size, power calculation, and trial registry and thereafter data on primary outcome measure, the direction of trial results and sponsorship. Of the 415 identified RCTs, 235 were excluded for our primary analysis, because the sponsorship was not reported. Of the 180 RCTs included in our analysis, 7 trials did not report on any primary outcome measure and 107 of the remaining 173 trials (62%) reported on surrogate primary outcome measures. Of the 114 registered trials, 21 trials (18%) provided primary outcomes in their manuscript that were different from those in the trial registry. This indicates selective outcome reporting. We found no association between selective outcome reporting and sponsorship. We ran additional analyses to include the trials that had not reported sponsorship and found no outcomes that differed from our primary analysis. Since the majority of the trials did not report on sponsorship, there is a risk on sampling bias. IVF and ICSI trials are subject, to

  18. Variation in adverse event incidence rates between hospitals and hospital departments. The Dutch adverse events study.

    NARCIS (Netherlands)

    Bruijne, M.C. de; Zegers, M.; Hoonhout, L.H.F.; Spreeuwenberg, P.M.M.; Groenewegen, P.P.; Wagner, C.

    2008-01-01

    Objective: To assess the variation in adverse event (AE) rates at the hospital and hospital department level, in order to gain insight in room for improvement of patient safety at each level. Methods: Randomly selected records of 7926 hospital admissions of 2004 from 4 university and 17 general

  19. Active classifier selection for RGB-D object categorization using a Markov random field ensemble method

    Science.gov (United States)

    Durner, Maximilian; Márton, Zoltán.; Hillenbrand, Ulrich; Ali, Haider; Kleinsteuber, Martin

    2017-03-01

    In this work, a new ensemble method for the task of category recognition in different environments is presented. The focus is on service robotic perception in an open environment, where the robot's task is to recognize previously unseen objects of predefined categories, based on training on a public dataset. We propose an ensemble learning approach to be able to flexibly combine complementary sources of information (different state-of-the-art descriptors computed on color and depth images), based on a Markov Random Field (MRF). By exploiting its specific characteristics, the MRF ensemble method can also be executed as a Dynamic Classifier Selection (DCS) system. In the experiments, the committee- and topology-dependent performance boost of our ensemble is shown. Despite reduced computational costs and using less information, our strategy performs on the same level as common ensemble approaches. Finally, the impact of large differences between datasets is analyzed.

  20. Implications of structural genomics target selection strategies: Pfam5000, whole genome, and random approaches

    Energy Technology Data Exchange (ETDEWEB)

    Chandonia, John-Marc; Brenner, Steven E.

    2004-07-14

    The structural genomics project is an international effort to determine the three-dimensional shapes of all important biological macromolecules, with a primary focus on proteins. Target proteins should be selected according to a strategy which is medically and biologically relevant, of good value, and tractable. As an option to consider, we present the Pfam5000 strategy, which involves selecting the 5000 most important families from the Pfam database as sources for targets. We compare the Pfam5000 strategy to several other proposed strategies that would require similar numbers of targets. These include including complete solution of several small to moderately sized bacterial proteomes, partial coverage of the human proteome, and random selection of approximately 5000 targets from sequenced genomes. We measure the impact that successful implementation of these strategies would have upon structural interpretation of the proteins in Swiss-Prot, TrEMBL, and 131 complete proteomes (including 10 of eukaryotes) from the Proteome Analysis database at EBI. Solving the structures of proteins from the 5000 largest Pfam families would allow accurate fold assignment for approximately 68 percent of all prokaryotic proteins (covering 59 percent of residues) and 61 percent of eukaryotic proteins (40 percent of residues). More fine-grained coverage which would allow accurate modeling of these proteins would require an order of magnitude more targets. The Pfam5000 strategy may be modified in several ways, for example to focus on larger families, bacterial sequences, or eukaryotic sequences; as long as secondary consideration is given to large families within Pfam, coverage results vary only slightly. In contrast, focusing structural genomics on a single tractable genome would have only a limited impact in structural knowledge of other proteomes: a significant fraction (about 30-40 percent of the proteins, and 40-60 percent of the residues) of each proteome is classified in small

  1. Clinical outcome of intracytoplasmic injection of spermatozoa morphologically selected under high magnification: a prospective randomized study.

    Science.gov (United States)

    Balaban, Basak; Yakin, Kayhan; Alatas, Cengiz; Oktem, Ozgur; Isiklar, Aycan; Urman, Bulent

    2011-05-01

    Recent evidence shows that the selection of spermatozoa based on the analysis of morphology under high magnification (×6000) may have a positive impact on embryo development in cases with severe male factor infertility and/or previous implantation failures. The objective of this prospective randomized study was to compare the clinical outcome of 87 intracytoplasmic morphologically selected sperm injection (IMSI) cycles with 81 conventional intracytoplasmic sperm injection (ICSI) cycles in an unselected infertile population. IMSI did not provide a significant improvement in the clinical outcome compared with ICSI although there were trends for higher implantation (28.9% versus 19.5%), clinical pregnancy (54.0% versus 44.4%) and live birth rates (43.7% versus 38.3%) in the IMSI group. However, severe male factor patients benefited from the IMSI procedure as shown by significantly higher implantation rates compared with their counterparts in the ICSI group (29.6% versus 15.2%, P=0.01). These results suggest that IMSI may improve IVF success rates in a selected group of patients with male factor infertility. New technological developments enable the real time examination of motile spermatozoa with an inverted light microscope equipped with high-power differential interference contrast optics, enhanced by digital imaging. High magnification (over ×6000) provides the identification of spermatozoa with a normal nucleus and nuclear content. Intracytoplasmic injection of spermatozoa selected according to fine nuclear morphology under high magnification may improve the clinical outcome in cases with severe male factor infertility. Copyright © 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  2. A Comparison of Dietary Habits between Recreational Runners and a Randomly Selected Adult Population in Slovenia.

    Science.gov (United States)

    Škof, Branko; Rotovnik Kozjek, Nada

    2015-09-01

    The aim of the study was to compare the dietary habits of recreational runners with those of a random sample of the general population. We also wanted to determine the influence of gender, age and sports performance of recreational runners on their basic diet and compliance with recommendations in sports nutrition. The study population consisted of 1,212 adult Slovenian recreational runners and 774 randomly selected residents of Slovenia between the ages of 18 and 65 years. The data on the dietary habits of our subjects was gathered by means of two questionnaires. The following parameters were evaluated: the type of diet, a food pattern, and the frequency of consumption of individual food groups, the use of dietary supplements, fluid intake, and alcohol consumption. Recreational runners had better compliance with recommendations for healthy nutrition than the general population. This pattern increased with the runner's age and performance level. Compared to male runners, female runners ate more regularly and had a more frequent consumption of food groups associated with a healthy diet (fruit, vegetables, whole grain foods, and low-fat dairy products). The consumption of simple sugars and use of nutritional supplements by well-trained runners was inadequate with values recommended for physically active individuals. Recreational runners are an exemplary population group that actively seeks to adopt a healthier lifestyle.

  3. Radiographic methods used before removal of mandibular third molars among randomly selected general dental clinics.

    Science.gov (United States)

    Matzen, Louise H; Petersen, Lars B; Wenzel, Ann

    2016-01-01

    To assess radiographic methods and diagnostically sufficient images used before removal of mandibular third molars among randomly selected general dental clinics. Furthermore, to assess factors predisposing for an additional radiographic examination. 2 observers visited 18 randomly selected clinics in Denmark and studied patient files, including radiographs of patients who had their mandibular third molar(s) removed. The radiographic unit and type of receptor were registered. A diagnostically sufficient image was defined as the whole tooth and mandibular canal were displayed in the radiograph (yes/no). Overprojection between the tooth and mandibular canal (yes/no) and patient-reported inferior alveolar nerve sensory disturbances (yes/no) were recorded. Regression analyses tested if overprojection between the third molar and the mandibular canal and an insufficient intraoral image predisposed for additional radiographic examination(s). 1500 mandibular third molars had been removed; 1090 had intraoral, 468 had panoramic and 67 had CBCT examination. 1000 teeth were removed after an intraoral examination alone, 433 after panoramic examination and 67 after CBCT examination. 90 teeth had an additional examination after intraoral. Overprojection between the tooth and mandibular canal was a significant factor (p < 0.001, odds ratio = 3.56) for an additional examination. 63.7% of the intraoral images were sufficient and 36.3% were insufficient, with no significant difference between images performed with phosphor plates and solid-state sensors (p = 0.6). An insufficient image predisposed for an additional examination (p = 0.008, odds ratio = 1.8) but was only performed in 11% of the cases. Most mandibular third molars were removed based on an intraoral examination although 36.3% were insufficient.

  4. X-ray film reject rate analysis at eight selected government hospitals ...

    African Journals Online (AJOL)

    The collected data were then entered into a database for analysis using descriptive statistics. Results: Reject rate was calculated in eight governmental hospitals across all plain film examinations. The overall reject rate was 374 (3.1 %) in 12,165 x-ray exposures. Total reject rate by hospital showed 10.5% for Zewditu and ...

  5. The Relationship between Hospital Financial Performance and Information Technology Integration Strategy Selection

    Science.gov (United States)

    Xie, Yue

    2012-01-01

    In light of the new healthcare regulations, hospitals are increasingly reevaluating their IT integration strategies to meet expanded healthcare information exchange requirements. Nevertheless, hospital executives do not have all the information they need to differentiate between the available strategies and recognize what may better fit their…

  6. Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Johnson-Warrington V

    2016-06-01

    Full Text Available Vicki Johnson-Warrington,1,2 Karen Rees,3 Colin Gelder,1 Mike Morgan,4 Sally J Singh2,41Department of Respiratory Medicine, University Hospitals Coventry and Warwickshire NHS Trust, 2Faculty of Health and Life Sciences, Coventry University, 3Warwick Medical School, University of Warwick, Coventry, 4Centre for Exercise and Rehabilitation Science, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK Introduction: Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD, a brief self-management program, may help address this issue.Objective: To investigate if SPACE for COPD employed upon hospital discharge would reduce readmission rates at 3 months, compared with usual care.Methods: This is a prospective, single-blinded, two-center trial (ISRCTN84599369 with participants admitted for an exacerbation, randomized to usual care or SPACE for COPD. Measures, including health-related quality of life and exercise capacity, were taken at baseline (hospital discharge and at 3 months. The primary outcome measure was respiratory readmission at 3 months.Results: Seventy-eight patients were recruited (n=39 to both groups. No differences were found in readmission rates or mortality at 3 months between the groups. Ten control patients were readmitted within 30 days compared to five patients in the intervention group (P>0.05. Both groups significantly improved their exercise tolerance and Chronic Respiratory Questionnaire (CRQ-SR results, with between-group differences approaching statistical significance for CRQ-dyspnea and CRQ-emotion, in favor of the intervention. The “Ready for Home” survey revealed that patients receiving the intervention reported feeling better able to arrange their life to cope with COPD, knew when to seek help about

  7. Comparison of Two Methods: Spinal Anesthesia and Ischiorectal Block on Post Hemorrhoidectomy Pain and Hospital Stay: A Randomized Control Trial.

    Science.gov (United States)

    Nadri, Sedigheh; Mahmoudvand, Hormoz; Rokrok, Shirin; Tarrahi, Mohammad Javad

    2017-11-27

    Hemorrhoidectomy is one of the most common hemorrhoid surgery. Many areas are innervated by nerves, and this makes the surgery to be very painful. Various anesthetic methods have been proposed, and the number of investigations and procedures demonstrated the absence of a reliable method for reducing pain. This study compares the cavity ischiorectal block with spinal anesthesia in reducing postoperative pain, analgesic consumption, and hospital stay. This study is a randomized control trial carried out on seventy patients sampled. Thirty-five (35) among them were placed in spinal anesthesia group, and the other 35 were placed in the ischiorectal block group. According to the study, questionnaire was designed in such a way that postoperative variables such as postoperative pain, analgesic consumption, changes in blood pressure, heart rate and hospital stay in both groups were evaluated and compared. IRCT2015111616516N3 ( http://en.search.irct.ir/search?query=IRCT2015111616516N3 ) Results: In this study, the pain scores on Visual Analogue Scale (VAS) at 0, 6, 12, and 24 hr for spinal anesthesia group after surgery were 0, 3.08 ± 0.78, 2.05 ± 1.02, 1.11 ± 0.83, respectively (p blocks were 0.98 ± 0.25, 1.57 ± 0.81, 0.91 ± 0.91, and 0.63 ± 0.31 respectively, which indicated lesser pain after surgery in the ischiorectal block at 6, 12, and 24 hr. In this study, out of the 35 patients that underwent spinal anesthesia, 28 patients (80%) were hospitalized in the first 6 hr, 13 patients (37.1%) in the second 6 hr, 3 patients (8.6%) in the second 12 hr after surgery. For patients under the ischiorectal block, the number of patients hospitalized were 13 patients (37.1%), in the first 6 hr, 4 patients (11.4%) in the second 6 hr, and 1 (2.9%) were hospitalized in the second 12 hr after surgery (p blocks causes less pain, require fewer painkillers, and reduces the hospital stay after surgery than spinal anesthesia.

  8. Does Selection and Management of Patients with Chronic Kidney Disease In Government Run and Private Hospitals Differ?

    Science.gov (United States)

    Gowda, Anoop; Dutt, Aswini Raghavendra; Bangera, Shobith

    2017-08-01

    Globally, incidence of Chronic Kidney Disease (CKD) is rapidly rising with huge burden on the life expectancy of the patients. Regular haemodialysis improves the quality of life in these patients. They get treatment at either government run or private sector hospitals. A difference in disease pattern, comorbidity, patient management and number of access failures can be observed in these set ups. The present study was carried out to find out selection, management and disease pattern of CKD patients admitted for dialysis in government run and private hospital. A cross-sectional study on patients (18-90 years) admitted and undergoing dialysis at government run (N=129) and private hospital (N=182) was undertaken in Karnataka, India. Parameters like comorbidity (diabetes), number of dialysis per week, number of access failures, and follow up visits were compared between these patients. Chi- squared test was used to compare the data. All tests were two-tailed and pprivate hospital patients (pprivate hospital. No statistical difference was seen with access failure in both these setups. No bias in management of CKD patient was seen among the two sets of hospitals though available facilities seemed to vary.

  9. Standardized Rehabilitation and Hospital Length of Stay Among Patients With Acute Respiratory Failure: A Randomized Clinical Trial.

    Science.gov (United States)

    Morris, Peter E; Berry, Michael J; Files, D Clark; Thompson, J Clifton; Hauser, Jordan; Flores, Lori; Dhar, Sanjay; Chmelo, Elizabeth; Lovato, James; Case, L Douglas; Bakhru, Rita N; Sarwal, Aarti; Parry, Selina M; Campbell, Pamela; Mote, Arthur; Winkelman, Chris; Hite, Robert D; Nicklas, Barbara; Chatterjee, Arjun; Young, Michael P

    2016-06-28

    Physical rehabilitation in the intensive care unit (ICU) may improve the outcomes of patients with acute respiratory failure. To compare standardized rehabilitation therapy (SRT) to usual ICU care in acute respiratory failure. Single-center, randomized clinical trial at Wake Forest Baptist Medical Center, North Carolina. Adult patients (mean age, 58 years; women, 55%) admitted to the ICU with acute respiratory failure requiring mechanical ventilation were randomized to SRT (n=150) or usual care (n=150) from October 2009 through May 2014 with 6-month follow-up. Patients in the SRT group received daily therapy until hospital discharge, consisting of passive range of motion, physical therapy, and progressive resistance exercise. The usual care group received weekday physical therapy when ordered by the clinical team. For the SRT group, the median (interquartile range [IQR]) days of delivery of therapy were 8.0 (5.0-14.0) for passive range of motion, 5.0 (3.0-8.0) for physical therapy, and 3.0 (1.0-5.0) for progressive resistance exercise. The median days of delivery of physical therapy for the usual care group was 1.0 (IQR, 0.0-8.0). Both groups underwent assessor-blinded testing at ICU and hospital discharge and at 2, 4, and 6 months. The primary outcome was hospital length of stay (LOS). Secondary outcomes were ventilator days, ICU days, Short Physical Performance Battery (SPPB) score, 36-item Short-Form Health Surveys (SF-36) for physical and mental health and physical function scale score, Functional Performance Inventory (FPI) score, Mini-Mental State Examination (MMSE) score, and handgrip and handheld dynamometer strength. Among 300 randomized patients, the median hospital LOS was 10 days (IQR, 6 to 17) for the SRT group and 10 days (IQR, 7 to 16) for the usual care group (median difference, 0 [95% CI, -1.5 to 3], P = .41). There was no difference in duration of ventilation or ICU care. There was no effect at 6 months for handgrip (difference, 2.0 kg [95% CI

  10. Case studies combined with or without concept maps improve critical thinking in hospital-based nurses: a randomized-controlled trial.

    Science.gov (United States)

    Huang, Yu-Chuan; Chen, Hsing-Hsia; Yeh, Mei-Ling; Chung, Yu-Chu

    2012-06-01

    Critical thinking (CT) is essential to the exercise of professional judgment. As nurses face increasingly complex health-care situations, critical thinking can promote appropriate clinical decision-making and improve the quality of nursing care. This study aimed to evaluate the effects of a program of case studies, alone (CS) or combined with concept maps (CSCM), on improving CT in clinical nurses. The study was a randomized controlled trial. The experimental group participated in a 16-week CSCM program, whereas the control group participated in a CS program of equal duration. A randomized-controlled trial with a multistage randomization process was used to select and to assign participants, ultimately resulting in 67 nurses in each group. Data were collected before and after the program using the California Critical Thinking Skill Test (CCTST) and the California Critical Thinking Disposition Inventory (CCTDI). After the programs, there were significant differences between the two groups in the critical thinking skills of analysis, evaluation, inference, deduction, and induction. There was also an overall significant difference, and a significant difference in the specific disposition of open-mindedness. This study supports the application of case studies combined with concept maps as a hospital-based teaching strategy to promote development of critical thinking skills and encourage dispositions for nurses. The CSCM resulted in greater improvements in all critical thinking skills of as well as the overall and open-minded affective dispositions toward critical thinking, compared with the case studies alone. An obvious improvement in the CSCM participants was the analytic skill and disposition. Further longitudinal studies and data collection from multisite evaluations in a range of geographic locales are warranted. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: a randomized controlled trial.

    Science.gov (United States)

    Cassileth, Barrie R; Vickers, Andrew J; Magill, Lucanne A

    2003-12-15

    High-dose therapy with autologous stem cell transplantation (HDT/ASCT) is a commonly used treatment for hematologic malignancies. The procedure causes significant psychological distress and no interventions have been demonstrated to improve mood in these patients. Music therapy has been shown to improve anxiety in a variety of acute medical settings. In the current study, the authors determined the effects of music therapy compared with standard care on mood during inpatient stays for HDT/ASCT. Patients with hematologic malignancy admitted for HDT/ASCT at two sites (Memorial Sloan-Kettering Cancer Center and Ireland Cancer Center in Cleveland, Ohio) were randomized to receive music therapy given by trained music therapists or standard care. Outcome was assessed at baseline and every 3 days after randomization using the Profile of Mood States. Of 69 patients registered in the study, follow-up data were available for 62 (90%). During their inpatient stay, patients in the music therapy group scored 28% lower on the combined Anxiety/Depression scale (P = 0.065) and 37% lower (P = 0.01) on the total mood disturbance score compared with controls. Music therapy is a noninvasive and inexpensive intervention that appears to reduce mood disturbance in patients undergoing HDT/ASCT. Copyright 2003 American Cancer Society.

  12. Control group selection in critical care randomized controlled trials evaluating interventional strategies: An ethical assessment.

    Science.gov (United States)

    Silverman, Henry J; Miller, Franklin G

    2004-03-01

    Ethical concern has been raised with critical care randomized controlled trials in which the standard of care reflects a broad range of clinical practices. Commentators have argued that trials without an unrestricted control group, in which standard practices are implemented at the discretion of the attending physician, lack the ability to redefine the standard of care and might expose subjects to excessive harms due to an inability to stop early. To develop a framework for analyzing control group selection for critical care trials. Ethical analysis. A key ethical variable in trial design is the extent with which the control group adequately reflects standard care practices. Such a control group might incorporate either the "unrestricted" practices of physicians or a protocol that specifies and restricts the parameters of standard practices. Control group selection should be determined with respect to the following ethical objectives of trial design: 1) clinical value, 2) scientific validity, 3) efficiency and feasibility, and 4) protection of human subjects. Because these objectives may conflict, control group selection will involve trade-offs and compromises. Trials using a protocolized rather than an unrestricted standard care control group will likely have enhanced validity. However, if the protocolized control group lacks representativeness to standard care practices, then trials that use such groups will offer less clinical value and could provide less assurance of protecting subjects compared with trials that use unrestricted control groups. For trials evaluating contrasting strategies that do not adequately represent standard practices, use of a third group that is more representative of standard practices will enhance clinical value and increase the ability to stop early if needed to protect subjects. These advantages might come at the expense of efficiency and feasibility. Weighing and balancing the competing ethical objectives of trial design should be

  13. Healthcare waste management in selected government and private hospitals in Southeast Nigeria

    Directory of Open Access Journals (Sweden)

    Angus Nnamdi Oli

    2016-01-01

    Conclusions: The availability of material for waste segregation at point of generation, compliance of healthcare workers to healthcare waste management guidelines and the existence of infection control committee in both hospitals is generally low and unsatisfactory.

  14. Evaluation of fungal air contamination in selected wards of two tertiary hospitals in Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Zahra Kamali Sarwestani

    2017-07-01

    Conclusion: According to the results of this study, the frequency and diversity of fungal spores in hospital wards were different. In addition, since the fungal contamination in the hospital environment are affected by various environmental factors and the efficiency of ventilation systems, some of these wards require better ventilation system as well as regular monitoring to remove these fungal bioaerosols in order to maintain the health of patients and health care workers.

  15. Cardio-pulmonary resuscitation challenges in selected Botswana hospitals: Nurse managers’ views

    Directory of Open Access Journals (Sweden)

    Lakshmi Rajeswaran

    2013-05-01

    Full Text Available Road traffic accident victims, as well as persons experiencing cardiac and other medical emergencies, might lose their lives due to the non-availability of trained personnel to provide effective cardio-pulmonary resuscitation (CPR with functional equipment and adequate resources.The objectives of the study were to identify unit managers’ perceptions about challenges encountered when performing CPR interventions in the two referral public hospitals in Botswana. These results could be used to recommend more effective CPR strategies for Botswana’s hospitals. Interviews, comprising two quantitative sections with closed ended questions and one qualitative section with semi-structured questions, were conducted with 22 unit managers. The quantitative data indicated that all unit managers had at least eight years’ nursing experience, and could identify CPR shortcomings in their hospitals. Only one interviewee had never performed CPR. The qualitative data analysis revealed that the hospital units sometimes had too few staff members and did not have fully equipped emergency trolleys and/or equipment. No CPR teams and no CPR policies and guidelines existed. Nurses and doctors reportedly lacked CPR knowledge and skills. No debriefing services were provided after CPR encounters. The participating hospitals should address the following challenges that might affect CPR outcomes: shortages of staff, overpopulation of hospital units, shortcomings of the emergency trolleys and CPR equipment, absence of CPR policies and guidelines, absence of CPR teams, limited CPR competencies of doctors and nurses and the lack of debriefing sessions after CPR attempts.

  16. Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation: a randomized trial.

    Science.gov (United States)

    Wik, Lars; Hansen, Trond Boye; Fylling, Frode; Steen, Thorbjørn; Vaagenes, Per; Auestad, Bjørn H; Steen, Petter Andreas

    2003-03-19

    Defibrillation as soon as possible is standard treatment for patients with ventricular fibrillation. A nonrandomized study indicates that after a few minutes of ventricular fibrillation, delaying defibrillation to give cardiopulmonary resuscitation (CPR) first might improve the outcome. To determine the effects of CPR before defibrillation on outcome in patients with ventricular fibrillation and with response times either up to or longer than 5 minutes. Randomized trial of 200 patients with out-of-hospital ventricular fibrillation in Oslo, Norway, between June 1998 and May 2001. Patients received either standard care with immediate defibrillation (n = 96) or CPR first with 3 minutes of basic CPR by ambulance personnel prior to defibrillation (n = 104). If initial defibrillation was unsuccessful, the standard group received 1 minute of CPR before additional defibrillation attempts compared with 3 minutes in the CPR first group. Primary end point was survival to hospital discharge. Secondary end points were hospital admission with return of spontaneous circulation (ROSC), 1-year survival, and neurological outcome. A prespecified analysis examined subgroups with response times either up to or longer than 5 minutes. In the standard group, 14 (15%) of 96 patients survived to hospital discharge vs 23 (22%) of 104 in the CPR first group (P =.17). There were no differences in ROSC rates between the standard group (56% [58/104]) and the CPR first group (46% [44/96]; P =.16); or in 1-year survival (20% [21/104] and 15% [14/96], respectively; P =.30). In subgroup analysis for patients with ambulance response times of either up to 5 minutes or shorter, there were no differences in any outcome variables between the CPR first group (n = 40) and the standard group (n = 41). For patients with response intervals of longer than 5 minutes, more patients achieved ROSC in the CPR first group (58% [37/64]) compared with the standard group (38% [21/55]; odds ratio [OR], 2.22; 95

  17. Randomized Controlled Trial of Hospital-Based Hygiene and Water Treatment Intervention (CHoBI7) to Reduce Cholera.

    Science.gov (United States)

    George, Christine Marie; Monira, Shirajum; Sack, David A; Rashid, Mahamud-ur; Saif-Ur-Rahman, K M; Mahmud, Toslim; Rahman, Zillur; Mustafiz, Munshi; Bhuyian, Sazzadul Islam; Winch, Peter J; Leontsini, Elli; Perin, Jamie; Begum, Farzana; Zohura, Fatema; Biswas, Shwapon; Parvin, Tahmina; Zhang, Xiaotong; Jung, Danielle; Sack, R Bradley; Alam, Munirul

    2016-02-01

    The risk for cholera infection is >100 times higher for household contacts of cholera patients during the week after the index patient seeks hospital care than it is for the general population. To initiate a standard of care for this high-risk population, we developed Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7), which promotes hand washing with soap and treatment of water. To test CHoBI7, we conducted a randomized controlled trial among 219 intervention household contacts of 82 cholera patients and 220 control contacts of 83 cholera patients in Dhaka, Bangladesh, during 2013-2014. Intervention contacts had significantly fewer symptomatic Vibrio cholerae infections than did control contacts and 47% fewer overall V. cholerae infections. Intervention households had no stored drinking water with V. cholerae and 14 times higher odds of hand washing with soap at key events during structured observation on surveillance days 5, 6, or 7. CHoBI7 presents a promising approach for controlling cholera among highly susceptible household contacts of cholera patients.

  18. The adverse effect of selective cyclooxygenase-2 inhibitor on random skin flap survival in rats.

    Directory of Open Access Journals (Sweden)

    Haiyong Ren

    Full Text Available BACKGROUND: Cyclooxygenase-2(COX-2 inhibitors provide desired analgesic effects after injury or surgery, but evidences suggested they also attenuate wound healing. The study is to investigate the effect of COX-2 inhibitor on random skin flap survival. METHODS: The McFarlane flap model was established in 40 rats and evaluated within two groups, each group gave the same volume of Parecoxib and saline injection for 7 days. The necrotic area of the flap was measured, the specimens of the flap were stained with haematoxylin-eosin(HE for histologic analysis. Immunohistochemical staining was performed to analyse the level of VEGF and COX-2 . RESULTS: 7 days after operation, the flap necrotic area ratio in study group (66.65 ± 2.81% was significantly enlarged than that of the control group(48.81 ± 2.33%(P <0.01. Histological analysis demonstrated angiogenesis with mean vessel density per mm(2 being lower in study group (15.4 ± 4.4 than in control group (27.2 ± 4.1 (P <0.05. To evaluate the expression of COX-2 and VEGF protein in the intermediate area II in the two groups by immunohistochemistry test .The expression of COX-2 in study group was (1022.45 ± 153.1, and in control group was (2638.05 ± 132.2 (P <0.01. The expression of VEGF in the study and control groups were (2779.45 ± 472.0 vs (4938.05 ± 123.6(P <0.01.In the COX-2 inhibitor group, the expressions of COX-2 and VEGF protein were remarkably down-regulated as compared with the control group. CONCLUSION: Selective COX-2 inhibitor had adverse effect on random skin flap survival. Suppression of neovascularization induced by low level of VEGF was supposed to be the biological mechanism.

  19. Effect of inhaled hypertonic saline on hospital admission rate in children with viral bronchiolitis: a randomized trial.

    Science.gov (United States)

    Kuzik, Brian A; Flavin, Michael P; Kent, Steven; Zielinski, David; Kwan, Charisse W; Adeleye, Adetayo; Vegsund, Bjorn C; Rossi, Carlo

    2010-11-01

    We sought to determine whether inhaled 3% hypertonic saline (HS) reduces admission to hospital in ambulatory children with moderately severe viral bronchiolitis. Secondary objectives compared changes in respiratory scores before and after treatment and assessed the need for unscheduled medical intervention within 7 days. Children under the age of 2 years presenting with moderately severe viral bronchiolitis to the emergency department of 4 general hospitals from November 2008 to March 2009 were randomly assigned to receive 3 consecutive 4-mL doses of nebulized 3% HS (treatment group) or 0.9% normal saline (NS; control group) in a double blind fashion, each coadministered with 1 mg salbutamol. Outcome measures included the difference in hospital admission rate and changes in respiratory distress scores. A total of 81 children (mean age 8.9 mo, range 0.7-22 mo) were assessed over 88 visits on an intention-to-treat basis. No statistically significant differences were found between treatment groups. Children in the HS group had a nonsignificant trend toward greater improvement compared with NS controls with a same-day admission rate of 18% (95% confidence interval [CI] 9%-32%) versus 27% (95% CI 16%-42%), respectively. Respiratory Assessment Change Scores (RACS) favoured the HS group over NS controls (mean RACS 4.7 [95% CI 3.6-5.8] v. 3.7 [95% CI 2.5-4.9], respectively), although the CIs overlap and these differences were not statistically significant. The short-term use of nebulized 3% HS did not result in any statistically significant benefits, although a nonsignificant trend toward a decrease in admission rate and improvement in respiratory distress was found. A larger study would be required to determine whether these trends arise from a clinically relevant treatment effect.

  20. Rapid selection of accessible and cleavable sites in RNA by Escherichia coli RNase P and random external guide sequences

    OpenAIRE

    Lundblad, Eirik W.; Xiao, Gaoping; Ko, Jae-hyeong; Altman, Sidney

    2008-01-01

    A method of inhibiting the expression of particular genes by using external guide sequences (EGSs) has been improved in its rapidity and specificity. Random EGSs that have 14-nt random sequences are used in the selection procedure for an EGS that attacks the mRNA for a gene in a particular location. A mixture of the random EGSs, the particular target RNA, and RNase P is used in the diagnostic procedure, which, after completion, is analyzed in a gel with suitable control lanes. Within a few ho...

  1. Short-term perioperative treatment with ambroxol reduces pulmonary complications and hospital costs after pulmonary lobectomy: a randomized trial.

    Science.gov (United States)

    Refai, Majed; Brunelli, Alessandro; Xiumé, Francesco; Salati, Michele; Sciarra, Valeria; Socci, Laura; Di Nunzio, Luca; Sabbatini, Armando

    2009-03-01

    To assess in a randomized clinical trial the influence of perioperative short-term ambroxol administration on postoperative complications, hospital stay and costs after pulmonary lobectomy for lung cancer. One hundred and forty consecutive patients undergoing lobectomy for lung cancer (April 2006-November 2007) were randomized in two groups. Group A (70 patients): ambroxol was administered by intravenous infusion in the context of the usual therapy on the day of operation and on the first 3 postoperative days (1000 mg/day). Group B (70 patients): fluid therapy only without ambroxol. Groups were compared in terms of occurrence of postoperative complications, length of stay and costs. There were no dropouts from either group and no complications related to treatment. The two groups were well matched for perioperative and operative variables. Compared to group B, group A (ambroxol) had a reduction of postoperative pulmonary complications (4 vs 13, 6% vs 19%, p=0.02), and unplanned ICU admission/readmission (1 vs 6, 1.4% vs 8.6%, p=0.1) rates. Moreover, the postoperative stay and costs were reduced by 2.5 days (5.6 vs 8.1, p=0.02) and 2765 Euro (2499 Euro vs 5264 Euro, p=0.04), respectively. Short-term perioperative treatment with ambroxol improved early outcome after lobectomy and may be used to implement fast-tracking policies and cut postoperative costs. Nevertheless, other independent trials are needed to verify the effect of this treatment in different settings.

  2. Adrenaline for out-of-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Lin, Steve; Callaway, Clifton W; Shah, Prakesh S; Wagner, Justin D; Beyene, Joseph; Ziegler, Carolyn P; Morrison, Laurie J

    2014-06-01

    The evidence for adrenaline in out-of-hospital cardiac arrest (OHCA) resuscitation is inconclusive. We systematically reviewed the efficacy of adrenaline for adult OHCA. We searched in MEDLINE, EMBASE, and Cochrane Library from inception to July 2013 for randomized controlled trials (RCTs) evaluating standard dose adrenaline (SDA) to placebo, high dose adrenaline (HDA), or vasopressin (alone or combination) in adult OHCA patients. Meta-analyses were performed using random effects modeling. Subgroup analyses were performed stratified by cardiac rhythm and by number of drug doses. The primary outcome was survival to discharge and the secondary outcomes were return of spontaneous circulation (ROSC), survival to admission, and neurological outcome. Fourteen RCTs (n=12,246) met inclusion criteria: one compared SDA to placebo (n=534), six compared SDA to HDA (n=6174), six compared SDA to an adrenaline/vasopressin combination (n=5202), and one compared SDA to vasopressin alone (n=336). There was no survival to discharge or neurological outcome differences in any comparison group, including subgroup analyses. SDA showed improved ROSC (RR 2.80, 95%CI 1.78-4.41, padrenaline. There was no benefit of adrenaline in survival to discharge or neurological outcomes. There were improved rates of survival to admission and ROSC with SDA over placebo and HDA over SDA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. A multicenter, randomized, double-blind, placebo-controlled, 6-month trial of bupropion hydrochloride sustained-release tablets as an aid to smoking cessation in hospital employees

    DEFF Research Database (Denmark)

    Dalsgareth, Oli Jacob; Hansen, Niels-Christian Gerner; Søes-Petersen, Ulrik

    2004-01-01

    Despite changes in smoking behavior, one-third of the Danish population continues to smoke. Many of these smokers are hospital employees. This 6-month, multicenter, parallel group, randomized, double-blind, placebo-controlled study evaluated treatment with bupropion hydrochloride sustained release...... (Zyban) compared with placebo as an aid to smoking cessation in health care workers. A total of 336 hospital employees who smoked at least 10 cigarettes daily were randomized (2:1) to 7 weeks of treatment with bupropion (n=222) or placebo (n=114). All participants were motivated to quit smoking......% in the bupropion group and 18% in the placebo group, p

  4. Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission--a randomized trial

    DEFF Research Database (Denmark)

    Kristoffersen, K B; Søgaard, O S; Wejse, C

    2009-01-01

    on antibiotic use in suspected lower respiratory tract infections (LRTIs) in a Danish hospital setting. In a randomized, controlled intervention study, 223 adult patients admitted to the hospital because of suspicion of LRTI were included with 210 patients available for analysis. Patients were randomized......Recent studies have suggested that procalcitonin (PCT) is a safe marker for the discrimination between bacterial and viral infection, and that PCT-guided treatment may lead to substantial reductions in antibiotic use. The present objective was to evaluate the effect of a single PCT measurement...

  5. Assessment of knowledge, attitude and practice and associated factors towards palliative care among nurses working in selected hospitals, Addis Ababa, Ethiopia.

    Science.gov (United States)

    Kassa, Hiwot; Murugan, Rajalakshmi; Zewdu, Fissiha; Hailu, Mignote; Woldeyohannes, Desalegn

    2014-03-04

    To provide quality care at the end of life or for chronically sick patients, nurses must have good knowledge, attitude and practice about palliative care (PC). In Ethiopia PC is new and very little is known about the type of services offered and the readiness of nurses to provide PC. A cross sectional quantitative study design was carried out using 341 nurses working in selected hospitals in Addis Ababa from January 2012 to May 2012. Systematic random sampling was the method employed to select two governmental and two non-governmental hospitals. The researchers used triangulation in their study method making use of: Frommelt's Attitude Toward Care of the Dying (FATCOD) Scale, Palliative Care Quiz for Nursing (PCQN) and practice questions. This led to enhanced validity of the data. EPI-INFO and SPSS software statistical packages were applied for data entry and analysis. Of the total 365 nurses selected, a response rate of 341 (94.2%) were registered. Out of the total study participants, 104 (30.5%) had good knowledge and 259 (76%) had favorable attitude towards PC. Medical and surgical wards as well as training on PC were positively associated with knowledge of nurses. Institution, individuals' level of education, working in medical ward and the training they took part on PC were also significantly associated with the attitude the nurses had. Nurses working in Hayat Hospital (nongovernmental) had a 71.5% chance of having unfavorable attitude towards PC than those working in Black Lion Hospital (governmental). Regarding their knowledge aspect of practice, the majority of the respondents 260 (76.2%) had poor implementation, and nearly half of the respondents had reported that the diagnosis of patients was usually performed at the terminal stage. In line with this, spiritual and medical conditions were highly taken into consideration while dealing with terminally ill patients. The nurses had poor knowledge and knowledge aspect of practice, but their attitude towards PC

  6. Assessment of knowledge, attitude and practice and associated factors towards palliative care among nurses working in selected hospitals, Addis Ababa, Ethiopia

    Science.gov (United States)

    2014-01-01

    Background To provide quality care at the end of life or for chronically sick patients, nurses must have good knowledge, attitude and practice about palliative care (PC). In Ethiopia PC is new and very little is known about the type of services offered and the readiness of nurses to provide PC. Methods A cross sectional quantitative study design was carried out using 341 nurses working in selected hospitals in Addis Ababa from January 2012 to May 2012. Systematic random sampling was the method employed to select two governmental and two non-governmental hospitals. The researchers used triangulation in their study method making use of: Frommelt’s Attitude Toward Care of the Dying (FATCOD) Scale, Palliative Care Quiz for Nursing (PCQN) and practice questions. This led to enhanced validity of the data. EPI-INFO and SPSS software statistical packages were applied for data entry and analysis. Result Of the total 365 nurses selected, a response rate of 341 (94.2%) were registered. Out of the total study participants, 104 (30.5%) had good knowledge and 259 (76%) had favorable attitude towards PC. Medical and surgical wards as well as training on PC were positively associated with knowledge of nurses. Institution, individuals’ level of education, working in medical ward and the training they took part on PC were also significantly associated with the attitude the nurses had. Nurses working in Hayat Hospital (nongovernmental) had a 71.5% chance of having unfavorable attitude towards PC than those working in Black Lion Hospital (governmental). Regarding their knowledge aspect of practice, the majority of the respondents 260 (76.2%) had poor implementation, and nearly half of the respondents had reported that the diagnosis of patients was usually performed at the terminal stage. In line with this, spiritual and medical conditions were highly taken into consideration while dealing with terminally ill patients. Conclusion The nurses had poor knowledge and knowledge aspect

  7. Breast milk supplementation and preterm infant development after hospital discharge: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Roxana Desterro e Silva da Cunha

    2016-04-01

    Full Text Available Abstract Objectives: To assess the effect of maternal breast milk supplementation on the development of exclusively breast-fed very low birth weight preterm infants at 12 months of corrected age. Methods: A randomized clinical trial with 53 infants followed-up after discharge from the neonatal unit until a corrected gestational age of 12 months. Newborns in the intervention group were breastfed exclusively with maternal milk and received 2 g of a multinutrient supplement (Pré-Nan®, Nestlé, Vevey, Switzerland added to expressed breast milk twice a day until a corrected age of 4–6 months. The control group was exclusively breastfed without supplementation. After monthly follow-up, developmental assessment was performed using the Bayley III Scale. Results: There was no statistically significant difference on the Bayley III Scale between the intervention and control groups in any of the assessed domains: motor, cognitive, and communication. However, scores in the three domains were always higher in the group that received the supplement. There were a similar number of cases of developmental delay in both groups: seven (28% in the group that received the supplement and nine (33.3% in the group that was exclusively breastfed. Conclusions: The results failed to show an association between post-discharge multinutrient supplementation and development in the assessed infants.

  8. Breast milk supplementation and preterm infant development after hospital discharge: a randomized clinical trial.

    Science.gov (United States)

    da Cunha, Roxana Desterro E Silva; Lamy Filho, Fernando; Rafael, Eremita Val; Lamy, Zeni Carvalho; de Queiroz, André Luiz Guimarães

    2016-01-01

    To assess the effect of maternal breast milk supplementation on the development of exclusively breast-fed very low birth weight preterm infants at 12 months of corrected age. A randomized clinical trial with 53 infants followed-up after discharge from the neonatal unit until a corrected gestational age of 12 months. Newborns in the intervention group were breastfed exclusively with maternal milk and received 2g of a multinutrient supplement (Pré-Nan(®), Nestlé, Vevey, Switzerland) added to expressed breast milk twice a day until a corrected age of 4-6 months. The control group was exclusively breastfed without supplementation. After monthly follow-up, developmental assessment was performed using the Bayley III Scale. There was no statistically significant difference on the Bayley III Scale between the intervention and control groups in any of the assessed domains: motor, cognitive, and communication. However, scores in the three domains were always higher in the group that received the supplement. There were a similar number of cases of developmental delay in both groups: seven (28%) in the group that received the supplement and nine (33.3%) in the group that was exclusively breastfed. The results failed to show an association between post-discharge multinutrient supplementation and development in the assessed infants. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  9. Effect of Losmapimod on Cardiovascular Outcomes in Patients Hospitalized With Acute Myocardial Infarction: A Randomized Clinical Trial.

    Science.gov (United States)

    O'Donoghue, Michelle L; Glaser, Ruchira; Cavender, Matthew A; Aylward, Philip E; Bonaca, Marc P; Budaj, Andrzej; Davies, Richard Y; Dellborg, Mikael; Fox, Keith A A; Gutierrez, Jorge Antonio T; Hamm, Christian; Kiss, Robert G; Kovar, František; Kuder, Julia F; Im, Kyung Ah; Lepore, John J; Lopez-Sendon, Jose L; Ophuis, Ton Oude; Parkhomenko, Alexandr; Shannon, Jennifer B; Spinar, Jindrich; Tanguay, Jean-Francois; Ruda, Mikhail; Steg, P Gabriel; Theroux, Pierre; Wiviott, Stephen D; Laws, Ian; Sabatine, Marc S; Morrow, David A

    2016-04-19

    p38 Mitogen-activated protein kinase (MAPK)-stimulated inflammation is implicated in atherogenesis, plaque destabilization, and maladaptive processes in myocardial infarction (MI). Pilot data in a phase 2 trial in non-ST elevation MI indicated that the p38 MAPK inhibitor losmapimod attenuates inflammation and may improve outcomes. To evaluate the efficacy and safety of losmapimod on cardiovascular outcomes in patients hospitalized with an acute myocardial infarction. LATITUDE-TIMI 60, a randomized, placebo-controlled, double-blind, parallel-group trial conducted at 322 sites in 34 countries from June 3, 2014, until December 8, 2015. Part A consisted of a leading cohort (n = 3503) to provide an initial assessment of safety and exploratory efficacy before considering progression to part B (approximately 22,000 patients). Patients were considered potentially eligible for enrollment if they had been hospitalized with an acute MI and had at least 1 additional predictor of cardiovascular risk. Patients were randomized to either twice-daily losmapimod (7.5 mg; n = 1738) or matching placebo (n = 1765) on a background of guideline-recommended therapy. Patients were treated for 12 weeks and followed up for an additional 12 weeks. The primary end point was the composite of cardiovascular death, MI, or severe recurrent ischemia requiring urgent coronary revascularization with the principal analysis specified at week 12. In part A, among the 3503 patients randomized (median age, 66 years; 1036 [29.6%] were women), 99.1% had complete ascertainment for the primary outcome. The primary end point occurred by 12 weeks in 123 patients treated with placebo (7.0%) and 139 patients treated with losmapimod (8.1%; hazard ratio, 1.16; 95% CI, 0.91-1.47; P = .24). The on-treatment rates of serious adverse events were 16.0% with losmapimod and 14.2% with placebo. Among patients with acute MI, use of losmapimod compared with placebo did not reduce the risk of major ischemic

  10. Exploring the relationship between accreditation and patient satisfaction - the case of selected Lebanese hospitals.

    Science.gov (United States)

    Haj-Ali, Wissam; Bou Karroum, Lama; Natafgi, Nabil; Kassak, Kassem

    2014-11-01

    Patient satisfaction is one of the vital attributes to consider when evaluating the impact of accreditation systems. This study aimed to explore the impact of the national accreditation system in Lebanon on patient satisfaction. An explanatory cross-sectional study of six hospitals in Lebanon. Patient satisfaction was measured using the SERVQUAL tool assessing five dimensions of quality (reliability, assurance, tangibility, empathy, and responsiveness). Independent variables included hospital accreditation scores, size, location (rural/urban), and patient demographics. The majority of patients (76.34%) were unsatisfied with the quality of services. There was no statistically significant association between accreditation classification and patient satisfaction. However, the tangibility dimension - reflecting hospital structural aspects such as physical facility and equipment was found to be associated with patient satisfaction. This study brings to light the importance of embracing more adequate patient satisfaction measures in the Lebanese hospital accreditation standards. Furthermore, the findings reinforce the importance of weighing the patient perspective in the development and implementation of accreditation systems. As accreditation is not the only driver of patient satisfaction, hospitals are encouraged to adopt complementary means of promoting patient satisfaction.

  11. Exploring the relationship between accreditation and patient satisfaction – the case of selected Lebanese hospitals

    Science.gov (United States)

    Haj-Ali, Wissam; Bou Karroum, Lama; Natafgi, Nabil; Kassak, Kassem

    2014-01-01

    Background: Patient satisfaction is one of the vital attributes to consider when evaluating the impact of accreditation systems. This study aimed to explore the impact of the national accreditation system in Lebanon on patient satisfaction. Methods: An explanatory cross-sectional study of six hospitals in Lebanon. Patient satisfaction was measured using the SERVQUAL tool assessing five dimensions of quality (reliability, assurance, tangibility, empathy, and responsiveness). Independent variables included hospital accreditation scores, size, location (rural/urban), and patient demographics. Results: The majority of patients (76.34%) were unsatisfied with the quality of services. There was no statistically significant association between accreditation classification and patient satisfaction. However, the tangibility dimension – reflecting hospital structural aspects such as physical facility and equipment was found to be associated with patient satisfaction. Conclusion: This study brings to light the importance of embracing more adequate patient satisfaction measures in the Lebanese hospital accreditation standards. Furthermore, the findings reinforce the importance of weighing the patient perspective in the development and implementation of accreditation systems. As accreditation is not the only driver of patient satisfaction, hospitals are encouraged to adopt complementary means of promoting patient satisfaction. PMID:25396210

  12. Exploring the Relationship between Accreditation and Patient Satisfaction – The Case of Selected Lebanese Hospitals

    Directory of Open Access Journals (Sweden)

    Wissam Haj-Ali

    2014-11-01

    Full Text Available Background Patient satisfaction is one of the vital attributes to consider when evaluating the impact of accreditation systems. This study aimed to explore the impact of the national accreditation system in Lebanon on patient satisfaction. Methods An explanatory cross-sectional study of six hospitals in Lebanon. Patient satisfaction was measured using the SERVQUAL tool assessing five dimensions of quality (reliability, assurance, tangibility, empathy, and responsiveness. Independent variables included hospital accreditation scores, size, location (rural/urban, and patient demographics. Results The majority of patients (76.34% were unsatisfied with the quality of services. There was no statistically significant association between accreditation classification and patient satisfaction. However, the tangibility dimension – reflecting hospital structural aspects such as physical facility and equipment was found to be associated with patient satisfaction. Conclusion This study brings to light the importance of embracing more adequate patient satisfaction measures in the Lebanese hospital accreditation standards. Furthermore, the findings reinforce the importance of weighing the patient perspective in the development and implementation of accreditation systems. As accreditation is not the only driver of patient satisfaction, hospitals are encouraged to adopt complementary means of promoting patient satisfaction.

  13. Random genetic drift, natural selection, and noise in human cranial evolution.

    Science.gov (United States)

    Roseman, Charles C

    2016-08-01

    This study assesses the extent to which relationships among groups complicate comparative studies of adaptation in recent human cranial variation and the extent to which departures from neutral additive models of evolution hinder the reconstruction of population relationships among groups using cranial morphology. Using a maximum likelihood evolutionary model fitting approach and a mixed population genomic and cranial data set, I evaluate the relative fits of several widely used models of human cranial evolution. Moreover, I compare the goodness of fit of models of cranial evolution constrained by genomic variation to test hypotheses about population specific departures from neutrality. Models from population genomics are much better fits to cranial variation than are traditional models from comparative human biology. There is not enough evolutionary information in the cranium to reconstruct much of recent human evolution but the influence of population history on cranial variation is strong enough to cause comparative studies of adaptation serious difficulties. Deviations from a model of random genetic drift along a tree-like population history show the importance of environmental effects, gene flow, and/or natural selection on human cranial variation. Moreover, there is a strong signal of the effect of natural selection or an environmental factor on a group of humans from Siberia. The evolution of the human cranium is complex and no one evolutionary process has prevailed at the expense of all others. A holistic unification of phenome, genome, and environmental context, gives us a strong point of purchase on these problems, which is unavailable to any one traditional approach alone. Am J Phys Anthropol 160:582-592, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  14. Pilot randomized trial of therapeutic hypothermia with serial cranial ultrasound and 18-22 month follow-up for neonatal encephalopathy in a low resource hospital setting in Uganda: study protocol

    National Research Council Canada - National Science Library

    Robertson, Nicola J; Hagmann, Cornelia F; Acolet, Dominique; Allen, Elizabeth; Nyombi, Natasha; Elbourne, Diana; Costello, Anthony; Jacobs, Ian; Nakakeeto, Margaret; Cowan, Frances

    2011-01-01

    .... Under the UCL Uganda Women's Health Initiative, a pilot randomized controlled trial in infants with perinatal asphyxia was set up in the special care baby unit in Mulago Hospital, a large public hospital...

  15. CURE-SMOTE algorithm and hybrid algorithm for feature selection and parameter optimization based on random forests.

    Science.gov (United States)

    Ma, Li; Fan, Suohai

    2017-03-14

    The random forests algorithm is a type of classifier with prominent universality, a wide application range, and robustness for avoiding overfitting. But there are still some drawbacks to random forests. Therefore, to improve the performance of random forests, this paper seeks to improve imbalanced data processing, feature selection and parameter optimization. We propose the CURE-SMOTE algorithm for the imbalanced data classification problem. Experiments on imbalanced UCI data reveal that the combination of Clustering Using Representatives (CURE) enhances the original synthetic minority oversampling technique (SMOTE) algorithms effectively compared with the classification results on the original data using random sampling, Borderline-SMOTE1, safe-level SMOTE, C-SMOTE, and k-means-SMOTE. Additionally, the hybrid RF (random forests) algorithm has been proposed for feature selection and parameter optimization, which uses the minimum out of bag (OOB) data error as its objective function. Simulation results on binary and higher-dimensional data indicate that the proposed hybrid RF algorithms, hybrid genetic-random forests algorithm, hybrid particle swarm-random forests algorithm and hybrid fish swarm-random forests algorithm can achieve the minimum OOB error and show the best generalization ability. The training set produced from the proposed CURE-SMOTE algorithm is closer to the original data distribution because it contains minimal noise. Thus, better classification results are produced from this feasible and effective algorithm. Moreover, the hybrid algorithm's F-value, G-mean, AUC and OOB scores demonstrate that they surpass the performance of the original RF algorithm. Hence, this hybrid algorithm provides a new way to perform feature selection and parameter optimization.

  16. The effects of vitamin C supplementation on pre-eclampsia in Mulago Hospital, Kampala, Uganda: a randomized placebo controlled clinical trial

    OpenAIRE

    Kiondo, Paul; Wamuyu-Maina, Gakenia; Wandabwa, Julius; Bimenya, Gabriel S; Tumwesigye, Nazarius Mbona; Okong, Pius

    2014-01-01

    Background Oxidative stress plays a role in the pathogenesis of pre-eclampsia. Supplementing women with antioxidants during pregnancy may reduce oxidative stress and thereby prevent or delay the onset pre-eclampsia. The objective of this study was to evaluate the effect of supplementing vitamin C in pregnancy on the incidence of pre-eclampsia, at Mulago hospital, Kampala, Uganda. Methods This was a (parallel, balanced randomization, 1:1) placebo randomized controlled trial conducted at Mulago...

  17. Comparison of the Utilization of Endoscopy Units in Selected Teaching Hospitals Across Canada

    Directory of Open Access Journals (Sweden)

    E Lalor

    1996-01-01

    Full Text Available There is no information on the number of endoscopic procedures performed at major teaching hospitals across Canada. The directors of endoscopy units at eight teaching hospitals from Halifax to Vancouver volunteered demographic information on the unit at their location. There was a very wide range of endoscopic utilization, with approximately comparable rates of out-patient versus in-patient procedures and of gastroscopies versus colonoscopies, but there was no obvious linking of the ratios of in-patients:out-patients versus total number of designated gastrointestinal beds or total number of hospital beds. Thus, the appropriateness of endoscopic procedures needs to be based on standards of practice and accepted indications. The number of endoscopies performed per endoscopy unit support staff varied widely (from 323.7 to 1065.3 per year, and it would be interesting to learn whether this represents an opportunity for cost-saving in some units.

  18. Noise-induced hearing loss in randomly selected New York dairy farmers.

    Science.gov (United States)

    May, J J; Marvel, M; Regan, M; Marvel, L H; Pratt, D S

    1990-01-01

    To understand better the effects of noise levels associated with dairy farming, we randomly selected 49 full-time dairy farmers from an established cohort. Medical and occupational histories were taken and standard audiometric testing was done. Forty-six males (94%) and three females (6%) with a mean age of 43.5 (+/- 13) years and an average of 29.4 (+/- 14) years in farming were tested. Pure Tone Average thresholds (PTA4) at 0.5, 1.0, 2.0, and 3.0 kHz plus High Frequency Average thresholds (HFA3) at 3.0, 4.0, and 6.0 kHz were calculated. Subjects with a loss of greater than or equal to 20 db in either ear were considered abnormal. Eighteen subjects (37%) had abnormal PTA4S and 32 (65%) abnormal HFA3S. The left ear was more severely affected in both groups (p less than or equal to .05, t-test). Significant associations were found between hearing loss and years worked (odds ratio 4.1, r = .53) and age (odds ratio 4.1, r = .59). No association could be found between hearing loss and measles; mumps; previous ear infections; or use of power tools, guns, motorcycles, snowmobiles, or stereo headphones. Our data suggest that among farmers, substantial hearing loss occurs especially in the high-frequency ranges. Presbycusis is an important confounding variable.

  19. Modeling Slotted Aloha as a Stochastic Game with Random Discrete Power Selection Algorithms

    Directory of Open Access Journals (Sweden)

    Rachid El-Azouzi

    2009-01-01

    Full Text Available We consider the uplink case of a cellular system where bufferless mobiles transmit over a common channel to a base station, using the slotted aloha medium access protocol. We study the performance of this system under several power differentiation schemes. Indeed, we consider a random set of selectable transmission powers and further study the impact of priorities given either to new arrival packets or to the backlogged ones. Later, we address a general capture model where a mobile transmits successfully a packet if its instantaneous SINR (signal to interferences plus noise ratio is lager than some fixed threshold. Under this capture model, we analyze both the cooperative team in which a common goal is jointly optimized as well as the noncooperative game problem where mobiles reach to optimize their own objectives. Furthermore, we derive the throughput and the expected delay and use them as the objectives to optimize and provide a stability analysis as alternative study. Exhaustive performance evaluations were carried out, we show that schemes with power differentiation improve significantly the individual as well as global performances, and could eliminate in some cases the bi-stable nature of slotted aloha.

  20. Do Hospitalized Premature Infants Benefit from Music Interventions? A Systematic Review of Randomized Controlled Trials.

    Science.gov (United States)

    van der Heijden, Marianne J E; Oliai Araghi, Sadaf; Jeekel, Johannes; Reiss, Irwin K M; Hunink, M G Myriam; van Dijk, Monique

    2016-01-01

    Neonatal intensive care units (NICU) around the world increasingly use music interventions. The most recent systematic review of randomized controlled trials (RCT) dates from 2009. Since then, 15 new RCTs have been published. We provide an updated systematic review on the possible benefits of music interventions on premature infants' well-being. We searched 13 electronic databases and 12 journals from their first available date until August 2016. Included were all RCTs published in English with at least 10 participants per group, including infants born prematurely and admitted to the NICU. Interventions were either recorded music interventions or live music therapy interventions. All control conditions were accepted as long as the effects of the music intervention could be analysed separately. A meta-analysis was not possible due to incompleteness and heterogeneity of the data. After removal of duplicates the searches retrieved 4893 citations, 20 of which fulfilled the inclusion/exclusion criteria. The 20 included studies encompassed 1128 participants receiving recorded or live music interventions in the NICU between 24 and 40 weeks gestational age. Twenty-six different outcomes were reported which we classified into three categories: physiological parameters; growth and feeding; behavioural state, relaxation outcomes and pain. Live music interventions were shown to improve sleep in three out of the four studies and heart rate in two out of the four studies. Recorded music improved heart rate in two out of six studies. Better feeding and sucking outcomes were reported in one study using live music and in two studies using recorded music. Although music interventions show promising results in some studies, the variation in quality of the studies, age groups, outcome measures and timing of the interventions across the studies makes it difficult to draw strong conclusions on the effects of music in premature infants.

  1. Do Hospitalized Premature Infants Benefit from Music Interventions? A Systematic Review of Randomized Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Marianne J E van der Heijden

    Full Text Available Neonatal intensive care units (NICU around the world increasingly use music interventions. The most recent systematic review of randomized controlled trials (RCT dates from 2009. Since then, 15 new RCTs have been published. We provide an updated systematic review on the possible benefits of music interventions on premature infants' well-being.We searched 13 electronic databases and 12 journals from their first available date until August 2016. Included were all RCTs published in English with at least 10 participants per group, including infants born prematurely and admitted to the NICU. Interventions were either recorded music interventions or live music therapy interventions. All control conditions were accepted as long as the effects of the music intervention could be analysed separately. A meta-analysis was not possible due to incompleteness and heterogeneity of the data.After removal of duplicates the searches retrieved 4893 citations, 20 of which fulfilled the inclusion/exclusion criteria. The 20 included studies encompassed 1128 participants receiving recorded or live music interventions in the NICU between 24 and 40 weeks gestational age. Twenty-six different outcomes were reported which we classified into three categories: physiological parameters; growth and feeding; behavioural state, relaxation outcomes and pain. Live music interventions were shown to improve sleep in three out of the four studies and heart rate in two out of the four studies. Recorded music improved heart rate in two out of six studies. Better feeding and sucking outcomes were reported in one study using live music and in two studies using recorded music.Although music interventions show promising results in some studies, the variation in quality of the studies, age groups, outcome measures and timing of the interventions across the studies makes it difficult to draw strong conclusions on the effects of music in premature infants.

  2. Day hospital Mentalization-based treatment versus intensive outpatient Mentalization-based treatment for patients with severe borderline personality disorder: protocol of a multicentre randomized clinical trial.

    Science.gov (United States)

    Laurenssen, Elisabeth M P; Smits, Maaike L; Bales, Dawn L; Feenstra, Dine J; Eeren, Hester V; Noom, Marc J; Köster, Maartje A; Lucas, Zwaan; Timman, Reinier; Dekker, Jack J M; Luyten, Patrick; Busschbach, Jan J V; Verheul, Roel

    2014-11-18

    Borderline personality disorder (BPD) is associated with a high socioeconomic burden. Although a number of evidence-based treatments for BPD are currently available, they are not widely disseminated; furthermore, there is a need for more research concerning their efficacy and cost-effectiveness. Such knowledge promises to lead to more efficient use of resources, which will facilitate the effective dissemination of these costly treatments. This study focuses on the efficacy and cost-effectiveness of Mentalization-Based Treatment (MBT), a manualized treatment for patients with BPD. Studies to date have either investigated MBT in a day hospitalization setting (MBT-DH) or MBT offered in an intensive outpatient setting (MBT-IOP). No trial has compared the efficacy and cost-effectiveness of these MBT programmes. As both interventions differ considerably in terms of intensity of treatment, and thus potentially in terms of efficacy and cost-effectiveness, there is a need for comparative trials. This study therefore sets out to investigate the efficacy and cost-effectiveness of MBT-DH versus MBT-IOP in patients with BPD. A secondary aim is to investigate the association between baseline measures and outcome, which might improve treatment selection and thus optimize efficacy and cost-effectiveness. A multicentre randomized controlled trial comparing MBT-DH versus MBT-IOP in severe BPD patients. Patients are screened for BPD using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and are assessed before randomization, at the start of treatment and 6, 12, 18, 24, 30 and 36 months after the start of treatment. Patients who refuse to participate will be offered care as usual in the same treatment centre. The primary outcome measure is symptom severity as measured by the Brief Symptom Inventory. Secondary outcome measures include parasuicidal behaviour, depression, substance use, social, interpersonal, and personality functioning, attachment, mentalizing

  3. Selected aspects of the logistics network of public hospitals in the competitive market of health services

    Directory of Open Access Journals (Sweden)

    Justyna Majchrzak-Lepczyk

    2016-12-01

    Full Text Available Background: The below considerations provide an overview of the issues of sustainable development, logistics, to financial engineering instruments and the role of intellectual capital in the process of transformation of public hospitals. The aim of this research was to assess the competitiveness of the network of public hospitals in the market of health services based on literature studies, as well as empirical research. Methods: Empirical study using a questionnaire survey was conducted in the period from January 2007 to December 2011, in the area of Warmia and Mazury, Pomerania and Wielkopolska. The goal of this questionnaire survey was to know the medical staff reviews issues related to adaptation to the nature of the network of public hospitals methods and logistics tools, sustainable development, corporate social responsibility - CSR. The study was carried out in 104 public hospitals, on a sample of 8975 respondents. Results and conclusions: Analysis of the completed study showed that the logistic processes and their improvement in the health sector play a significant role. The surveyed entities explicitly draw attention to the need for information systems,  pro-environment activities, access to information, or the use of GS1 global standards. These tools allow you to increase the efficiency of supply chains, ensuring not only tracking and tracing of products from the manufacturer to the patient, but also enabling better protection against making a mistake or counterfeit products.

  4. The prevalence of symptoms associated with pulmonary tuberculosis in randomly selected children from a high burden community

    OpenAIRE

    Marais, B.; Obihara, C; Gie, R.; Schaaf, H; Hesseling, A.; Lombard, C.; Enarson, D; Bateman, E; Beyers, N

    2005-01-01

    Background: Diagnosis of childhood tuberculosis is problematic and symptom based diagnostic approaches are often promoted in high burden settings. This study aimed (i) to document the prevalence of symptoms associated with tuberculosis among randomly selected children living in a high burden community, and (ii) to compare the prevalence of these symptoms in children without tuberculosis to those in children with newly diagnosed tuberculosis.

  5. The proportion of unmet costs considering inpatients billing of selected hospitals, after 2014 Health System reform implementation in Isfahan Province.

    Science.gov (United States)

    Naghdi, Parnaz; Mohammadi, Mahan; Jahangard, Mohammad Ali; Yousefe, Alireza; Rafiee, Noora

    2017-01-01

    Since 2013, in Iran's health care, the contribution of direct payments for health-care services was estimated more than 50 % of all expenditures. In May 2014, Iran's health-care reform was established to improve health services quality and reduce patients' out-of-pocket payments reform coverage mentioned in Sections 1.2.2 and 1.2.1, Article 6 of the Health Minister Reform Guideline) in the inpatient billings within the first 5 months from the reform implementation. This study was conducted as a cross-sectional research in the second half of 2014 on the selected hospitals in Isfahan Province. Data were collected by investigating 97,000 inpatients' billing records issued by 28 hospitals affiliated to Isfahan University of Medical Sciences using census method. Findings of the study showed that the average of unmet costs paid by the inpatients constituted 21.8% of the total billing costs in 28 hospitals, and the average unmet costs paid by each patient was 1,903,832 Rials. Considering the definition of unmet cost in the context of health-care reform guideline and hospitals' problems in providing some costly services, drugs, and medical equipment (that were not covered by insurance organizations and the reform scheme) within the obligations of the reform, it is necessary to review these obligations and further interact with insurance companies about expanding the coverage to some costly services required by the patients.

  6. Rapid selection of accessible and cleavable sites in RNA by Escherichia coli RNase P and random external guide sequences.

    Science.gov (United States)

    Lundblad, Eirik W; Xiao, Gaoping; Ko, Jae-Hyeong; Altman, Sidney

    2008-02-19

    A method of inhibiting the expression of particular genes by using external guide sequences (EGSs) has been improved in its rapidity and specificity. Random EGSs that have 14-nt random sequences are used in the selection procedure for an EGS that attacks the mRNA for a gene in a particular location. A mixture of the random EGSs, the particular target RNA, and RNase P is used in the diagnostic procedure, which, after completion, is analyzed in a gel with suitable control lanes. Within a few hours, the procedure is complete. The action of EGSs designed by an older method is compared with EGSs designed by the random EGS method on mRNAs from two bacterial pathogens.

  7. Differential privacy-based evaporative cooling feature selection and classification with relief-F and random forests.

    Science.gov (United States)

    Le, Trang T; Simmons, W Kyle; Misaki, Masaya; Bodurka, Jerzy; White, Bill C; Savitz, Jonathan; McKinney, Brett A

    2017-09-15

    Classification of individuals into disease or clinical categories from high-dimensional biological data with low prediction error is an important challenge of statistical learning in bioinformatics. Feature selection can improve classification accuracy but must be incorporated carefully into cross-validation to avoid overfitting. Recently, feature selection methods based on differential privacy, such as differentially private random forests and reusable holdout sets, have been proposed. However, for domains such as bioinformatics, where the number of features is much larger than the number of observations p≫n , these differential privacy methods are susceptible to overfitting. We introduce private Evaporative Cooling, a stochastic privacy-preserving machine learning algorithm that uses Relief-F for feature selection and random forest for privacy preserving classification that also prevents overfitting. We relate the privacy-preserving threshold mechanism to a thermodynamic Maxwell-Boltzmann distribution, where the temperature represents the privacy threshold. We use the thermal statistical physics concept of Evaporative Cooling of atomic gases to perform backward stepwise privacy-preserving feature selection. On simulated data with main effects and statistical interactions, we compare accuracies on holdout and validation sets for three privacy-preserving methods: the reusable holdout, reusable holdout with random forest, and private Evaporative Cooling, which uses Relief-F feature selection and random forest classification. In simulations where interactions exist between attributes, private Evaporative Cooling provides higher classification accuracy without overfitting based on an independent validation set. In simulations without interactions, thresholdout with random forest and private Evaporative Cooling give comparable accuracies. We also apply these privacy methods to human brain resting-state fMRI data from a study of major depressive disorder. Code

  8. Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial

    NARCIS (Netherlands)

    Wik, L.; Olsen, J.A.; Persse, D.; Sterz, F.; Lozano Jr, M.; Brouwer, M.A.; Westfall, M.; Souders, C.M.; Malzer, R.; Grunsven, P.M. van; Travis, D.T.; Whitehead, A.; Herken, U.R.; Lerner, E.B.

    2014-01-01

    OBJECTIVE: To compare integrated automated load distributing band CPR (iA-CPR) with high-quality manual CPR (M-CPR) to determine equivalence, superiority, or inferiority in survival to hospital discharge. METHODS: Between March 5, 2009 and January 11, 2011 a randomized, unblinded, controlled group

  9. Bayesian dose selection design for a binary outcome using restricted response adaptive randomization.

    Science.gov (United States)

    Meinzer, Caitlyn; Martin, Renee; Suarez, Jose I

    2017-09-08

    In phase II trials, the most efficacious dose is usually not known. Moreover, given limited resources, it is difficult to robustly identify a dose while also testing for a signal of efficacy that would support a phase III trial. Recent designs have sought to be more efficient by exploring multiple doses through the use of adaptive strategies. However, the added flexibility may potentially increase the risk of making incorrect assumptions and reduce the total amount of information available across the dose range as a function of imbalanced sample size. To balance these challenges, a novel placebo-controlled design is presented in which a restricted Bayesian response adaptive randomization (RAR) is used to allocate a majority of subjects to the optimal dose of active drug, defined as the dose with the lowest probability of poor outcome. However, the allocation between subjects who receive active drug or placebo is held constant to retain the maximum possible power for a hypothesis test of overall efficacy comparing the optimal dose to placebo. The design properties and optimization of the design are presented in the context of a phase II trial for subarachnoid hemorrhage. For a fixed total sample size, a trade-off exists between the ability to select the optimal dose and the probability of rejecting the null hypothesis. This relationship is modified by the allocation ratio between active and control subjects, the choice of RAR algorithm, and the number of subjects allocated to an initial fixed allocation period. While a responsive RAR algorithm improves the ability to select the correct dose, there is an increased risk of assigning more subjects to a worse arm as a function of ephemeral trends in the data. A subarachnoid treatment trial is used to illustrate how this design can be customized for specific objectives and available data. Bayesian adaptive designs are a flexible approach to addressing multiple questions surrounding the optimal dose for treatment efficacy

  10. Comparing Some Production Functions for Inpatient Health Services in Selected Public Hospitals in Spain.

    Science.gov (United States)

    Antelo, Manel; Reyes-Santiás, Francisco; Cadarso-Suárez, Carmen; Rodríguez-Álvarez, María Xosé

    2017-01-01

    To investigate the adequacy of the widely used Cobb-Douglas and transcendental logarithmic (translog) models of the production functions of hospital inpatient services, the authors fitted these and additive models to data for the four most productive health services of 10 public hospitals in Galicia, Spain (the same four in each). Production, measured as admissions weighted in accordance with their diagnosis-related groups (DRGs), was treated as a function of physician full-time equivalents as surrogate labor factor and number of beds as surrogate capital factor. The results suggest that while the Cobb-Douglas and translog models suffice to represent the production functions of services with low average DRG weight, the greater flexibility of additive models is required for services with higher average DRG weight when only these two inputs are considered.

  11. Unblinded randomized control trial on prophylactic antibiotic use in gustilo II open tibia fractures at Kenyatta National Hospital, Kenya.

    Science.gov (United States)

    Ondari, Joshua Nyaribari; Masika, Moses Muia; Ombachi, Richard Bwana; Ating'a, John Ernest

    2016-10-01

    To determine the difference in infection rate between 24h versus five days of prophylactic antibiotic use in management of Gustilo II open tibia fractures. Unblinded randomized control trial. Accident and Emergency, orthopedic wards and outpatient clinics at Kenyatta National Hospital (KNH). The study involved patients aged 18-80 years admitted through accident and emergency department with Gustilo II traumatic open tibia fractures. Patients were randomized into either 24hour or five day group and antibiotics started for 24hours or five days after surgical debridement. The wounds were exposed and scored using ASEPSIS wound scoring system for infection after 48h, 5days and at 14days. The main outcomes of interest were presence of infection at days 2, 5 and 14 and effect of duration to antibiotic administration on infection rate. There was no significant difference in infection rates between 24-hour and 5-day groups with infection rates of 23% (9/40) vs. 19% (7/37) respectively (p=0.699). The infection rate was significantly associated with time lapsed before administration of antibiotics (p=0.004). In the use of prophylactic antibiotics for the management of Gustilo II traumatic open tibia fractures, there is no difference in infection rate between 24hours and five days regimen but time to antibiotic administration correlates with infection rate. Antibiotic use for 24hours only has proven adequate prophylaxis against infection. This is underlined in our study which we hope shall inform practice in our setting. A larger, more appropriately controlled study would be useful. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Vancomycin gene selection in the microbiome of urban Rattus norvegicus from hospital environment

    DEFF Research Database (Denmark)

    Arn Hansen, Thomas; Joshi, Tejal; Larsen, Anders Rhod

    2016-01-01

    argued that animal vectors such as Rattus norvegicus (R. norvegicus) living in hospital sewage systems are ideal for carrying pathogens responsible for fatal diseases in humans. Using a metagenomic sequencing approach, we investigated faecal samples of R. norvegicus from three major cities....... norvegicus microbiome, potentially driven by the outflow of antibiotics and antibiotic-resistant bacteria into the wastewater systems. Carriage of vancomycin resistance may suggest that R. norvegicus is acting as a reservoir for possible transmission to the human population....

  13. [The relation of selected psychiatric disorders to occurrence of suicide attempts among teenage psychiatrically hospitalized patients].

    Science.gov (United States)

    Krajewska, Katarzyna; Gawlik-Kotelnicka, Oliwia; Gmitrowicz, Agnieszka

    2015-06-01

    Suicide is the third cause of death globally in the age group 10-19. Multiple risk factors (genetic, psychiatric, psychological, familial, social) increased number of suicide attempts. The aim of this study was to explore whether mental disorders are associated with the number of suicide attempts among psychiatric hospitalized adolescents. Retrospective, chart-based analysis of 119 patients, aged 13-18, treated in 2013-2014 in the Department of Adolescent Psychiatry in Łódź. Inclusion criteria was diagnosis of schizophrenia, schizotypal and delusional disorders, mood disorders, neurotic, stress-related and somatoform disorders, behavioral and emotional disorders according to ICD 10. Exclusion criteria were other psychiatric diagnosis, incomplete information about intention of self-harm behaviors. For statistical analysis used Statistica 9.1. Among psychiatricaly hospitalized patients, 51.2% of people attempted suicide. No relationship was found (p > 0.05) between psychiatric diagnosis and frequency of suicide attempts in adolescents, but the most common suicide attempts related to people with a diagnosis of mood disorders (59.3%) and neurotic disorders (54.6%), and least frequently in patients with a diagnosis of schizophrenia , schizotypal and delusional disorders (40%) and behavioral and emotional disorders (44.4%). There is no relation between the occurrence of suicide attempts and the type of mental disorders among psychiatrically hospitalized adolescents. © 2015 MEDPRESS.

  14. Antibiogram profie of Pseudomonas aeruginosa isolated from some selected hospital environmental drains

    Directory of Open Access Journals (Sweden)

    Ekioba Olohigbe Imanah

    2017-10-01

    Full Text Available Objective: To isolate, identify and characterize Pseudomonas aeruginosa (P. aeruginosa from hospital drains using culture-based and PCR methods. Methods: Wastewater samples were obtained from hospital drains between August and October, 2015, using standard culture-based methods for isolation of P. aeruginosa. The isolates were further confirmed by specie-specific primer sets. Antimicrobial susceptibility testing of the isolates was conducted using the Kirby-Bauer disc diffusion method. Results: The mean P. aeruginosa population densities were expressed ranging between (1.7 × 105 ± 0.1 and (6.1 × 105 ± 0.2 CFU/mL. The antimicrobial susceptibility profile of the P. aeruginosa isolates revealed that all the isolates 96/96 (100% were resistant to penicillins (amoxicillin and cloxacillin as well as penicillin/β-lactamase inhibitor (augmentin while sensitivity was observed in carbapenems [imipenem 96/96 (100%]. The multiple antimicrobial resistance index of the P. aeruginosa to the antimicrobials used ranged from 0.33 to 0.89 while the multidrug resistant profile revealed resistance to augmentin, amoxicillin, cloxacillin. Conclusions: The present study reveals that hospital drains are potential reservoirs of multiple antibiotic resistances of P. aeruginosa.

  15. Adherence to prescribed antihypertensive medications and associated factors for hypertensive patients attending chronic follow-up units of selected public hospitals in Addis Ababa, Ethiopia.

    Science.gov (United States)

    Tibebu, Abel; Mengistu, Daniel; Bulto, Lemma Negesa

    2017-01-01

    The study was aimed at assessing adherence to prescribed antihypertensive medications and its associated factors. Institutional-based cross-sectional study was conducted in four public hospitals which were selected by lottery method. Systematic random sampling was used to select the study subjects. Data were checked, cleaned, and entered into Epidata software version 3.1 and were imported to SPSS version 21 software for analysis. The results of the descriptive statistics were expressed as percentages and frequencies. Associations between independent variables and dependent variable were analyzed using bivariate and multivariate analysis. The study was conducted from February 15 to April 15, 2016. The study included 404 respondents with 97% response rate. 210 (52%) were male and mean age was 54 ± 10.77 years. The respondents' adherence to antihypertensive medications was 66.8%. The medication-related adherences were found to be better in females, patients who had comorbidities and have been knowledgeable about the disease and was poor among young adult respondents. This study found out a 66.8% adherence to prescribed antihypertensive medications. This figures show that medication adherence (MA) rates are low. The factors impeding or enhancing the outcome variable was thoroughly analyzed. Sex, age, number of types of medications, and knowledge were associated with MA. Educational sessions that especially focus on MA and ongoing support for patients should be designed. Studies which assess all the components of self-management should be conducted for comparison among different subgroups.

  16. Generation of Aptamers from A Primer-Free Randomized ssDNA Library Using Magnetic-Assisted Rapid Aptamer Selection

    Science.gov (United States)

    Tsao, Shih-Ming; Lai, Ji-Ching; Horng, Horng-Er; Liu, Tu-Chen; Hong, Chin-Yih

    2017-04-01

    Aptamers are oligonucleotides that can bind to specific target molecules. Most aptamers are generated using random libraries in the standard systematic evolution of ligands by exponential enrichment (SELEX). Each random library contains oligonucleotides with a randomized central region and two fixed primer regions at both ends. The fixed primer regions are necessary for amplifying target-bound sequences by PCR. However, these extra-sequences may cause non-specific bindings, which potentially interfere with good binding for random sequences. The Magnetic-Assisted Rapid Aptamer Selection (MARAS) is a newly developed protocol for generating single-strand DNA aptamers. No repeat selection cycle is required in the protocol. This study proposes and demonstrates a method to isolate aptamers for C-reactive proteins (CRP) from a randomized ssDNA library containing no fixed sequences at 5‧ and 3‧ termini using the MARAS platform. Furthermore, the isolated primer-free aptamer was sequenced and binding affinity for CRP was analyzed. The specificity of the obtained aptamer was validated using blind serum samples. The result was consistent with monoclonal antibody-based nephelometry analysis, which indicated that a primer-free aptamer has high specificity toward targets. MARAS is a feasible platform for efficiently generating primer-free aptamers for clinical diagnoses.

  17. Cardio-pulmonary resuscitation challenges in selected Botswana hospitals: Nurse managers’ views

    Directory of Open Access Journals (Sweden)

    Lakshmi Rajeswaran

    2013-05-01

    Full Text Available Road traffic accident victims, as well as persons experiencing cardiac and other medical emergencies, might lose their lives due to the non-availability of trained personnel to provide effective cardio-pulmonary resuscitation (CPR with functional equipment and adequate resources. The objectives of the study were to identify unit managers’ perceptions about challenges encountered when performing CPR interventions in the two referral public hospitals in Botswana. These results could be used to recommend more effective CPR strategies for Botswana’s hospitals. Interviews, comprising two quantitative sections with closed ended questions and one qualitative section with semi-structured questions, were conducted with 22 unit managers. The quantitative data indicated that all unit managers had at least eight years’ nursing experience, and could identify CPR shortcomings in their hospitals. Only one interviewee had never performed CPR. The qualitative data analysis revealed that the hospital units sometimes had too few staff members and did not have fully equipped emergency trolleys and/or equipment. No CPR teams and no CPR policies and guidelines existed. Nurses and doctors reportedly lacked CPR knowledge and skills. No debriefing services were provided after CPR encounters. The participating hospitals should address the following challenges that might affect CPR outcomes: shortages of staff, overpopulation of hospital units, shortcomings of the emergency trolleys and CPR equipment, absence of CPR policies and guidelines, absence of CPR teams, limited CPR competencies of doctors and nurses and the lack of debriefing sessions after CPR attempts. Die slagoffers van padongelukke, asook persone wat hart- en ander mediese noodtoestande ervaar, kan hulle lewens verloor omdat daar nie opgeleide personeel met funksionele toerusting en voldoende hulpbronne beskikbaar is om effektiewe kardiopulmonale resussitasie (KPR te doen nie. Die studie het ten doel

  18. Coexistence of free-living amoebae and bacteria in selected South African hospital water distribution systems.

    Science.gov (United States)

    Muchesa, P; Leifels, M; Jurzik, L; Hoorzook, K B; Barnard, T G; Bartie, C

    2017-01-01

    Pathogenic free-living amoebae (FLA), such as Naegleria fowleri, Balamuthia mandrillaris and Acanthamoeba species isolated from aquatic environments have been implicated in central nervous system, eye and skin human infections. They also allow the survival, growth and transmission of bacteria such as Legionella, Mycobacteria and Vibrio species in water systems. The purpose of this study was to investigate the co-occurrence of potentially pathogenic FLA and their associated bacteria in hospital water networks in Johannesburg, South Africa. A total of 178 water (n = 95) and swab (n = 83) samples were collected from two hospital water distribution systems. FLA were isolated using the amoebal enrichment technique and identified using PCR and 18S rDNA sequencing. Amoebae potentially containing intra-amoebal bacteria were lysed and cultured on blood agar plates. Bacterial isolates were characterized using the VITEK®2 compact System. Free-living amoebae were isolated from 77 (43.3 %) of the samples. Using microscopy, PCR and 18S rRNA sequencing, Acanthamoeba spp. (T3 and T20 genotypes), Vermamoeba vermiformis and Naegleria gruberi specie were identified. The Acanthamoeba T3 and T20 genotypes have been implicated in eye and central nervous system infections. The most commonly detected bacterial species were Serratia marcescens, Stenotrophomonas maltophilia, Delftia acidovorans, Sphingomonas paucimobilis and Comamonas testosteroni. These nosocomial pathogenic bacteria are associated with systematic blood, respiratory tract, the urinary tract, surgical wounds and soft tissues infections. The detection of FLA and their associated opportunistic bacteria in the hospital water systems point out to a potential health risk to immune-compromised individuals.

  19. Drug and Therapeutics (D & T) committees in Dutch hospitals : a nation-wide survey of structure, activities, and drug selection procedures

    NARCIS (Netherlands)

    Fijn, R; Brouwers, JRBJ; Knaap, RJ; De Jong-Van den Berg, LTW

    Aims To determine structure, activities and drug selection processes used by Dutch hospital drug and therapeutics (D & T) committees. Methods A pretested structured survey questionnaire based on the Australian process and impact indicators, previous research, and consultation of professionals was

  20. STUDY OF PRESCRIBING PATTERN OF ANTIMICROBIAL AGENTS IN SELECTED PATIENTS ATTENDING TERTIARY CARE HOSPITAL IN INDIA

    Directory of Open Access Journals (Sweden)

    Anjan Adhikari

    2013-06-01

    Full Text Available Antibiotics are the most commonly prescribed drugs in hospitals and their irrational use is one of the important factors for the development and spread of resistance. The objective of this study was to evaluate the antibiotic prescription pattern in the patient attending the tertiary care hospital. It was found that a total of 333 antibiotics where prescribed in 245 prescriptions. The average number of antibiotics per prescription was approximately1.4. The most commonly used antibiotics were moxifloxacin 19.5%, metronidazole 10.4%, amoxicillin + cloxacillin 10.2% and ciprofloxacin 6%. antibiotics were almost equally prescribed to both male and female. 45.5% of the antibiotics shows adherence with the National List of Essential Medicines of India. 76.6% of the antibiotics were single products while 23.4% were fixed dose combination. The most commonly used dosage forms were tablets (57%, drops (23.5% and creams (11.7%.57.3% were prescribed irrationally. Quinolones (48.2% and antifungals (21.5% were the most common types of prescribed antibiotics in which irrationality was found.

  1. Maternal near miss and predictive ability of potentially life-threatening conditions at selected maternity hospitals in Latin America.

    Science.gov (United States)

    De Mucio, Bremen; Abalos, Edgardo; Cuesta, Cristina; Carroli, Guillermo; Serruya, Suzanne; Giordano, Daniel; Martinez, Gerardo; Sosa, Claudio G; Souza, João Paulo

    2016-11-04

    Every year millions of women around the world suffer from pregnancy, childbirth and postpartum complications. Women who survive the most serious clinical conditions are regarded as to have experienced a severe acute maternal complication called maternal near miss (MNM). Information about MNM cases may complement the data collected through the analysis of maternal death, and was proposed as a helpful tool to identify strengths and weaknesses of health systems in relation to maternal health care. The purpose of this study is to evaluate the performance of a systematized form to detect severe maternal outcomes (SMO) in 20 selected maternity hospitals from Latin America (LAC). Cross-sectional study. Data were obtained from analysis of hospital records for all women giving birth and all women who had a SMO in the selected hospitals. Univariate and multivariate adjusted logistic regression models were used to assess the predictive ability of different conditions to identify SMO cases. In parallel, external auditors were hired for reviewing and reporting the total number of discharges during the study period, in order to verify whether health professionals at health facilities identified all MNM and Potentially life-threatening condition (PLTC) cases. Twenty hospitals from twelve LAC were initially included in the study and based on the level of coverage, 11 hospitals with a total of 3,196records were included for the final analysis. The incidence of SMO and MNM outcomes was 12.9 and 12.3 per 1,000 live births, respectively. The ratio of MNM to maternal death was 19 to 1, with a mortality index of 5.1 %. Both univariate and multivariate analysis showed a good performance for a number of clinical and laboratory conditions to predict a severe maternal outcome, however, their clinical relevance remains to be confirmed. Coherence between health professionals and external auditors to identify SMO was high (around 100 %). The form tested, was well accepted by health

  2. Selected Organizational Factors Affecting Performance of Professional Nurses in North West Bank Governmental Hospitals

    Science.gov (United States)

    Thulth, Ahida Saleem; Sayej, Sumaya

    2015-01-01

    Background: Organizational factors are considered to be the cornerstone in achieving psychological and professional security at work, which in turn are positively reflected in job performance both quantitatively and qualitatively. Aim of the Study: The study aimed to assess of selected organizational factors (workload, available recourses and…

  3. The basic science and mathematics of random mutation and natural selection.

    Science.gov (United States)

    Kleinman, Alan

    2014-12-20

    The mutation and natural selection phenomenon can and often does cause the failure of antimicrobial, herbicidal, pesticide and cancer treatments selection pressures. This phenomenon operates in a mathematically predictable behavior, which when understood leads to approaches to reduce and prevent the failure of the use of these selection pressures. The mathematical behavior of mutation and selection is derived using the principles given by probability theory. The derivation of the equations describing the mutation and selection phenomenon is carried out in the context of an empirical example. Copyright © 2014 John Wiley & Sons, Ltd.

  4. Use of hyaluronan in the selection of sperm for intracytoplasmic sperm injection (ICSI): significant improvement in clinical outcomes--multicenter, double-blinded and randomized controlled trial.

    Science.gov (United States)

    Worrilow, K C; Eid, S; Woodhouse, D; Perloe, M; Smith, S; Witmyer, J; Ivani, K; Khoury, C; Ball, G D; Elliot, T; Lieberman, J

    2013-02-01

    Does the selection of sperm for ICSI based on their ability to bind to hyaluronan improve the clinical pregnancy rates (CPR) (primary end-point), implantation (IR) and pregnancy loss rates (PLR)? In couples where ≤ 65% of sperm bound hyaluronan, the selection of hyaluronan-bound (HB) sperm for ICSI led to a statistically significant reduction in PLR. HB sperm demonstrate enhanced developmental parameters which have been associated with successful fertilization and embryogenesis. Sperm selected for ICSI using a liquid source of hyaluronan achieved an improvement in IR. A pilot study by the primary author demonstrated that the use of HB sperm in ICSI was associated with improved CPR. The current study represents the single largest prospective, multicenter, double-blinded and randomized controlled trial to evaluate the use of hyaluronan in the selection of sperm for ICSI. Using the hyaluronan binding assay, an HB score was determined for the fresh or initial (I-HB) and processed or final semen specimen (F-HB). Patients were classified as >65% or ≤ 65% I-HB and stratified accordingly. Patients with I-HB scores ≤ 65% were randomized into control and HB selection (HYAL) groups whereas patients with I-HB >65% were randomized to non-participatory (NP), control or HYAL groups, in a ratio of 2:1:1. The NP group was included in the >65% study arm to balance the higher prevalence of patients with I-HB scores >65%. In the control group, oocytes received sperm selected via the conventional assessment of motility and morphology. In the HYAL group, HB sperm meeting the same visual criteria were selected for injection. Patient participants and clinical care providers were blinded to group assignment. Eight hundred two couples treated with ICSI in 10 private and hospital-based IVF programs were enrolled in this study. Of the 484 patients stratified to the I-HB > 65% arm, 115 participants were randomized to the control group, 122 participants were randomized to the HYAL group

  5. Postoperative use of drain in thyroid lobectomy – a randomized clinical trial conducted at Civil Hospital, Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    Memon Zahid

    2012-09-01

    Full Text Available Abstract Background Thyroidectomy is a common surgical procedure, after which drains are placed routinely. This study aims to assess the benefits of placing postoperative drains, its complications and affects on postoperative stay, in thyroid lobectomy. Methodology Randomized Clinical Trial of 60 goitre patients undergoing lobectomy was conducted at Civil Hospital Karachi, during July’11-December’11. Patients were randomly assigned into drain and non drain groups. Patient demographics, labs and complications were noted. Ultrasound of neck was performed on both groups. For drain group, the amount of fluid present in the surgical bed and redivac drain was added to calculate fluid collection while in non drain group it was calculated by ultrasound of neck on first and second post-op days. Data was entered and analyzed on SPSS v16 using Independent T tests. Result The mean total drain output for 2 days in non-drain group was significantly lower 10.67 (±9.072 ml while in drain group was 30.97 (±42.812 ml (p = 0.014. The mean postoperative stay of drain group (79.2 ±15.63 hours was significantly higher, as compared to mean postoperative stay of non drain group (50.4 ±7.32 hours. Mean Visual Analogue Score (VAS for pain day 1 (6.2 ±0.997 and day 2 (4.17 ±0.95 in drain group were significantly higher compared to day 1 (2.6 ±1.163 and day 2 (1.3 ±0.877 of non drain group. From drain group, 2 patients complained of stridor, dyspnea on Day 1 which subsided by Day 2 and 1 case of voice change, with no such complains in non drain group. No patients from both groups developed seroma, wound infection or hematoma. Conclusion In uncomplicated surgeries especially for lobectomy, use of drain can be omitted.

  6. Misoprostol in addition to routine treatment of postpartum hemorrhage: A hospital-based randomized-controlled trial in Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    Blum Jennifer

    2008-08-01

    Full Text Available Abstract Background Postpartum hemorrhage (PPH remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment. Methods A randomized controlled trial was conducted in four Karachi hospitals from December 2005 – April 2007 to assess the benefit of a 600 mcg dose of misoprostol given sublingually in addition to standard oxytocics for postpartum hemorrhage treatment. Consenting women had their blood loss measured after normal vaginal delivery and were enrolled in the study after losing more than 500 ml of blood. Women were randomly assigned to receive either 600 mcg sublingual misoprostol or matching placebo in addition to standard PPH treatment with injectable oxytocics. Both women and providers were blinded to the treatment assignment. Blood loss was collected until active bleeding stopped and for a minimum of one hour after PPH diagnosis. Total blood loss, hemoglobin measures, and treatment outcomes were recorded for all participants. Results Due to a much lower rate of PPH than expected (1.2%, only sixty-one patients were diagnosed and treated for their PPH in this study, and we were therefore unable to measure statistical significance in any of the primary endpoints. The addition of 600 mcg sublingual misoprostol to standard PPH treatments does, however, suggest a trend in reduced postpartum blood loss, a smaller drop in postpartum hemoglobin, and need for fewer additional interventions. Women who bled less overall had a significantly smaller drop in hemoglobin and received fewer additional interventions. There were no hysterectomies or

  7. Resistance training in the early postoperative phase reduces hospitalization and leads to muscle hypertrophy in elderly hip surgery patients--a controlled, randomized study

    DEFF Research Database (Denmark)

    Suetta, Charlotte; Magnusson, S Peter; Rosted, Anna

    2004-01-01

    OBJECTIVES: To better understand how immobilization and surgery affect muscle size and function in the elderly and to identify effective training regimes. DESIGN: A prospective randomized, controlled study. SETTING: Bispebjerg University Hospital, Copenhagen, Denmark. PARTICIPANTS: Thirty...... resistance training of the operated side (3/wk x 12 weeks). MEASUREMENTS: Hospital length of stay (LOS), quadriceps muscle cross-sectional area (CSA), isokinetic muscle strength, and functional performance. Patients were tested presurgery and 5 and 12 weeks postsurgery. RESULTS: Mean+/-standard error LOS...... was shorter for the resistance training group (10.0+/-2.4 days, Pmuscle strength (22-28%, Pmuscle...

  8. Areas of Hospitality Management and Stakeholders in Recruitment and Selection Multiple Case Study: Estanplaza, Travel in and Transamérica.

    Directory of Open Access Journals (Sweden)

    Thiago Sbarai Santos Alves

    2014-06-01

    Full Text Available This research aims to analyze the relationships between recruitment and selection and its stakeholders, considering the areas of hospitality and its characteristics as influential factors to recruit and select new employees. The research approach was qualitative methodologies for the study of multiple cases, which contributed to the form of empirical research. For this investigation were selected by three chains together features that enabled a comparative analysis of the study, which were used for data collection, three sources of evidence: interviews, direct observations and documentation. The selected networks, Estanplaza Hotels, Hotels Transamerica and Travel Inn Hotels The overall goal was to understand the processes used in recruitment and selection set features the fields of hospitality. From this issue were established specific objectives: to observe the dynamics of recruitment and selection of chains; analyze the content related to the fields of hospitality in the tools used in the process of recruitment and selection, and meet stakeholders in this area. The research was conducted through interviews with managers of lodging facilities and with stakeholders in the area of recruitment and selection, based on a semistructured interview guide. Through this research, we found that some features of the fields of hospitality are considered in the process of recruitment and selection. Chains surveyed, however, point out that it is necessary to use tools and processes that enable this type of analysis.

  9. Randomized trial of a novel game-based appointment system for a university hospital venereology unit: study protocol.

    Science.gov (United States)

    Gabarron, Elia; Serrano, J Artur; Fernandez-Luque, Luis; Wynn, Rolf; Schopf, Thomas

    2015-04-08

    Chlamydia is the most common reportable sexually transmitted disease (STD) in Norway, and its incidence in the two northernmost counties has been disclosed to be nearly the double of the Norwegian average. The latest publicly available rates showed that 85.6% of the new cases were diagnosed in people under 29 years old. The information and communication technologies are among the most powerful influences in the lives of young people. The Internet can potentially represent a way to educate on sexual health and encourage young people, and especially youth, to be tested for STDs. If hospital websites include an easy and anonymous system for scheduling appointments with the clinic, it is possible that this could lead to an increase in the number of people tested for STDs. The purpose of the study is to assess the impact of a game-based appointment system on the frequency of consultations at a venereology unit and on the use of an educational web app. An A/B testing methodology is used. Users from the city of Tromsø, in North Norway, will be randomized to one of the two versions of the game-style web app on sexual health at www.sjekkdeg.no. Group A will have access to educational content only, while group B will have, in addition, access to a game-based appointment system with automatic prioritization. After one year of the trial, it will be analyzed if the game-based appointment system increases the number of consultations at the venereology unit and if health professionals deem the system useful. This study will explore if facilitating the access to health services for youth through the use of a game-based appointment system integrated in a game-style web app on sexual health education can have an impact on appointment rates. The trial is registered at clinicaltrials.org under the identifier ClinicalTrials.gov NCT:02128620.

  10. [Repair of primary inguinal hernia: Lichtenstein versus Shouldice techniques. Prospective randomized study of pain and hospital costs].

    Science.gov (United States)

    Porrero, José L; Bonachía, Oscar; López-Buenadicha, Adolfo; Sanjuanbenito, Alfonso; Sánchez-Cabezudo, Carlos

    2005-02-01

    Hernia is one of the most widely studied processes, and the search for excellence has become the final aim. However, many controversies remain to be resolved. The objective of the present study was to analyze postoperative pain and costs using two techniques of primary inguinal hernia repair. We performed a prospective, randomized study of 54 patients who underwent surgical repair of inguinal hernia through either the Lichtenstein or the Shouldice technique between June 2001 and May 2002. The following variables were analyzed: age, location and type of hernia, evaluation of tolerance to local anesthesia, surgical technique, operating time, pain at days 1, 3 and 5 after surgery, analgesic consumption, days until driving could be resumed, days off work, and occupation. The patient groups were similar, with no significant differences in age, location or type of hernia. For Lichtenstein hernioplasty, operating time was lower (p < 0.01); pain evaluation showed no significant differences on days 1 and 3 after surgery but was higher on day 5 (p = 0.064). No significant differences were found in analgesic consumption, time before driving could be resumed, or days off work. Freelance patients returned to work earlier, independently of the surgical technique performed. The cost of the Lichtenstein technique was 235 euros compared with 180 euros for the Shouldice technique and this difference was statistically significant (p < 0.05). In the hands of expert surgeons, the Shouldice technique is the procedure of choice in the repair of primary hernias. The results are just as satisfactory as those obtained with Lichtenstein hernioplasty and hospital costs are lower.

  11. Interactive media as a tool for reducing waiting anxiety at paediatric rehabilitation hospitals: a randomized controlled trial.

    Science.gov (United States)

    Biddiss, Elaine; Knibbe, Tara Joy; Fehlings, Darcy; Mckeever, Patricia; Cohen, Ashley; Mcpherson, Amy

    2017-12-15

    To investigate the efficacy of waiting room media for reducing anxiety and increasing satisfaction at a paediatric rehabilitation hospital. In this clustered, parallel, randomized controlled trial, 310 young people with disabilities (age range 5-19y) and their parents attending outpatient clinics were assigned to interactive media (n=113), a silent nature video (n=97), or media-free comparison (n=100) groups. Young person and parent anxiety was reported using the State-Trait Anxiety Inventory (STAI) on arrival and after 10 minutes in the waiting space. Questionnaires measured young person, parent, and staff satisfaction. Young people exposed to interactive media reported a postexposure state anxiety that was 1.1 raw points (2.7 standardized points) lower on the STAI than the comparison group (95% confidence interval [CI] -1.9 to -0.22). There was no difference in postexposure state anxiety between the passive media and comparison groups (95% CI -0.64 to 1.1). Parents' state anxiety did not differ between conditions, but interactive media were associated with greater satisfaction (p=0.009). Of 120 staff, 119 reported that interactive media improved the clinic experience for families. Interactive media designed for accessible, hands-free play mitigate waiting anxiety and increases satisfaction. This paper provides evidence to guide design and decision-making around the use of interactive media in health care spaces. Interactive media reduced preclinic waiting anxiety for young people with disabilities. Interactive media were accessible to young people with a range of mobility. Interactive media increased parental and staff satisfaction in the clinic. Guidelines for the design of hands-free, inclusive interactive media for health care facilities are presented. © 2017 Mac Keith Press.

  12. Novel random peptide libraries displayed on AAV serotype 9 for selection of endothelial cell-directed gene transfer vectors.

    Science.gov (United States)

    Varadi, K; Michelfelder, S; Korff, T; Hecker, M; Trepel, M; Katus, H A; Kleinschmidt, J A; Müller, O J

    2012-08-01

    We have demonstrated the potential of random peptide libraries displayed on adeno-associated virus (AAV)2 to select for AAV2 vectors with improved efficiency for cell type-directed gene transfer. AAV9, however, may have advantages over AAV2 because of a lower prevalence of neutralizing antibodies in humans and more efficient gene transfer in vivo. Here we provide evidence that random peptide libraries can be displayed on AAV9 and can be utilized to select for AAV9 capsids redirected to the cell type of interest. We generated an AAV9 peptide display library, which ensures that the displayed peptides correspond to the packaged genomes and performed four consecutive selection rounds on human coronary artery endothelial cells in vitro. This screening yielded AAV9 library capsids with distinct peptide motifs enabling up to 40-fold improved transduction efficiencies compared with wild-type (wt) AAV9 vectors. Incorporating sequences selected from AAV9 libraries into AAV2 capsids could not increase transduction as efficiently as in the AAV9 context. To analyze the potential on endothelial cells in the intact natural vascular context, human umbilical veins were incubated with the selected AAV in situ and endothelial cells were isolated. Fluorescence-activated cell sorting analysis revealed a 200-fold improved transduction efficiency compared with wt AAV9 vectors. Furthermore, AAV9 vectors with targeting sequences selected from AAV9 libraries revealed an increased transduction efficiency in the presence of human intravenous immunoglobulins, suggesting a reduced immunogenicity. We conclude that our novel AAV9 peptide library is functional and can be used to select for vectors for future preclinical and clinical gene transfer applications.

  13. The effect of written material and verbal method education on anxiety and depression in patients with myocardial infarction in selected hospitals in Iran.

    Science.gov (United States)

    Aghakhani, Nader; Khademvatan, Kamal; Dehghani, Mohammad Reza

    2014-10-01

    Myocardial infarction (MI) is the damage to the heart muscle, or myocardium, resulting from the lack of blood flow to the heart. MI patients experience mental and emotional problems such as depression and anxiety. These complications could cause delay in resuming work, decreased quality of life and increased risk of death. The role of education in facilitating adaptation is very important in these patients. The purpose of this study was to determine the effect of written material and verbal method education on anxiety and depression in patients with myocardial infarction in Urmia hospital in 2009. This study was a quasi-experimental study, comparing the effect of education on anxiety and depression in patients with myocardial infarction in hospitals affiliated to Urmia University of Medical Science. 124 patients were selected randomly and divided into two groups. The experimental group was educated through face to face training and an educational booklet (Written Material and Verbal Method). The control group did not receive any intervention. The level of anxiety and depression was evaluated, using HADS questionnaire at 3 intervals: after 48 hours of admission, the discharge day and 2 months after discharge. The findings suggested that MI patients were worried about their social role, interpersonal relations and personal health. Such problems can aggravate symptoms and complicate the future care. There was no significant difference between the control and experimental groups before the intervention, but after the intervention, anxiety and depression in the experimental group was significantly less than that in the control group (panxiety and depression in cases with myocardial infarction, this may be one of the health care goals. More research on more patients is required to achieve more conclusive results.

  14. Does implementing a development plan for user participation in a mental hospital change patients' experience? A non-randomized controlled study.

    Science.gov (United States)

    Rise, Marit B; Steinsbekk, Aslak

    2015-10-01

    Governments in several countries attempt to strengthen user participation through instructing health-care organizations to implement user participation initiatives. There is, however, little knowledge on the effect on patients' experience from comprehensive plans for enhancing user participation in whole health service organizations. To investigate whether implementing a development plan intending to enhance user participation in a mental hospital had any effect on the patients' experience of user participation. A non-randomized controlled study including patients in three mental hospitals in Central Norway, one intervention hospital and two control hospitals. A development plan intended to enhance user participation was implemented in the intervention hospital as a part of a larger reorganizational process. The plan included establishment of a patient education centre and a user office, purchase of user expertise, appointment of contact professionals for next of kin and improvement of the centre's information and the professional culture. Perceptions of Care, Inpatient Treatment Alliance Scale and questions made for this study. A total of 1651 patients participated. Implementing a development plan in a mental hospital intending to enhance user participation had no significant effect on the patients' experience of user participation. The lack of effect can be due to inappropriate initiatives or challenges in implementation processes. Further research should ensure that initiatives and implementation processes are appropriate to impact the patients' experience. © 2013 John Wiley & Sons Ltd.

  15. [Selection and optimal sequence of critical elements for medication review: A simulation with hospital pharmacy residents].

    Science.gov (United States)

    Dubois, S; Barbier, A; Thibault, M; Atkinson, S; Bussières, J-F

    2017-03-01

    The main objective of this study was to compare the responses of pharmacy residents regarding critical steps for medication order review, in the presence or absence of clinical pharmacists on patient care units, to describe the sequence of these steps and to compare them to an optimal sequence. The secondary objectives were to test this sequence in a simulation and to assess the residents' level of agreement on medication order review. Twenty-two validation steps were selected from guidelines. A simulation on order review was organized in three steps: selecting elements judged to be necessary or not for the order review critical path, then organizing this sequence in chronological order, implementation of this critical path on two simulated practical cases, resident perceptions about order review in their training. Forty-one residents participated in the activity. Responses were heterogeneous regarding the elements' sequence and the time required for the review of a simulated case (3-13minutes). A majority of residents considered that their training was insufficient (29/41), that pharmacists validated differently (27/41), and that it was impossible to review the 22 proposed items for each prescription (30/41). This article highlights heterogeneous medication order review practices among pharmacy residents, due to a lack of training in their curriculum according to them. It is essential to acquire medication order review standard both locally and nationally. Copyright © 2016 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

  16. A Randomized Trial to Determine the Impact of an Educational Patient Hand-Hygiene Intervention on Contamination of Hospitalized Patient's Hands with Healthcare-Associated Pathogens.

    Science.gov (United States)

    Sunkesula, Venkata C K; Kundrapu, Sirisha; Knighton, Shanina; Cadnum, Jennifer L; Donskey, Curtis J

    2017-05-01

    We conducted a non-blinded randomized trial to determine the impact of a patient hand-hygiene intervention on contamination of hospitalized patients' hands with healthcare-associated pathogens. Among patients with negative hand cultures on admission, recovery of pathogens from hands was significantly reduced in those receiving the intervention versus those receiving standard care. Infect Control Hosp Epidemiol 2017;38:595-597.

  17. Random amplification of polymorphic DNA (RAPD), pulsed-field gel electrophoresis (PFGE) and phage-typing in the analysis of a hospital outbreak of Salmonella enteritidis

    DEFF Research Database (Denmark)

    Skibsted, U.; Baggesen, Dorte Lau; Dessau, R.

    1998-01-01

    Isolates of Salmonella Enteritidis from 81 patients from Herlev Hospital or from Copenhagen County were analysed by random amplification of polymorphic DNA (RAPD), pulsed-field gel electrophoresis (PFGE) and phage-typing. Fourteen polymorphic markers from five decamer primers unambiguously placed...... that RAPD is useful as a tool in investigations of microbial outbreaks in its own right, or to supplement phage-typing and PFGE of Salmonella Enteritidis....

  18. The Jackprot Simulation Couples Mutation Rate with Natural Selection to Illustrate How Protein Evolution Is Not Random

    Science.gov (United States)

    Espinosa, Avelina; Bai, Chunyan Y.

    2016-01-01

    Protein evolution is not a random process. Views which attribute randomness to molecular change, deleterious nature to single-gene mutations, insufficient geological time, or population size for molecular improvements to occur, or invoke “design creationism” to account for complexity in molecular structures and biological processes, are unfounded. Scientific evidence suggests that natural selection tinkers with molecular improvements by retaining adaptive peptide sequence. We used slot-machine probabilities and ion channels to show biological directionality on molecular change. Because ion channels reside in the lipid bilayer of cell membranes, their residue location must be in balance with the membrane's hydrophobic/philic nature; a selective “pore” for ion passage is located within the hydrophobic region. We contrasted the random generation of DNA sequence for KcsA, a bacterial two-transmembrane-domain (2TM) potassium channel, from Streptomyces lividans, with an under-selection scenario, the “jackprot,” which predicted much faster evolution than by chance. We wrote a computer program in JAVA APPLET version 1.0 and designed an online interface, The Jackprot Simulation http://faculty.rwu.edu/cbai/JackprotSimulation.htm, to model a numerical interaction between mutation rate and natural selection during a scenario of polypeptide evolution. Winning the “jackprot,” or highest-fitness complete-peptide sequence, required cumulative smaller “wins” (rewarded by selection) at the first, second, and third positions in each of the 161 KcsA codons (“jackdons” that led to “jackacids” that led to the “jackprot”). The “jackprot” is a didactic tool to demonstrate how mutation rate coupled with natural selection suffices to explain the evolution of specialized proteins, such as the complex six-transmembrane (6TM) domain potassium, sodium, or calcium channels. Ancestral DNA sequences coding for 2TM-like proteins underwent nucleotide

  19. The Jackprot Simulation Couples Mutation Rate with Natural Selection to Illustrate How Protein Evolution Is Not Random.

    Science.gov (United States)

    Paz-Y-Miño C, Guillermo; Espinosa, Avelina; Bai, Chunyan Y

    2011-09-01

    Protein evolution is not a random process. Views which attribute randomness to molecular change, deleterious nature to single-gene mutations, insufficient geological time, or population size for molecular improvements to occur, or invoke "design creationism" to account for complexity in molecular structures and biological processes, are unfounded. Scientific evidence suggests that natural selection tinkers with molecular improvements by retaining adaptive peptide sequence. We used slot-machine probabilities and ion channels to show biological directionality on molecular change. Because ion channels reside in the lipid bilayer of cell membranes, their residue location must be in balance with the membrane's hydrophobic/philic nature; a selective "pore" for ion passage is located within the hydrophobic region. We contrasted the random generation of DNA sequence for KcsA, a bacterial two-transmembrane-domain (2TM) potassium channel, from Streptomyces lividans, with an under-selection scenario, the "jackprot," which predicted much faster evolution than by chance. We wrote a computer program in JAVA APPLET version 1.0 and designed an online interface, The Jackprot Simulation http://faculty.rwu.edu/cbai/JackprotSimulation.htm, to model a numerical interaction between mutation rate and natural selection during a scenario of polypeptide evolution. Winning the "jackprot," or highest-fitness complete-peptide sequence, required cumulative smaller "wins" (rewarded by selection) at the first, second, and third positions in each of the 161 KcsA codons ("jackdons" that led to "jackacids" that led to the "jackprot"). The "jackprot" is a didactic tool to demonstrate how mutation rate coupled with natural selection suffices to explain the evolution of specialized proteins, such as the complex six-transmembrane (6TM) domain potassium, sodium, or calcium channels. Ancestral DNA sequences coding for 2TM-like proteins underwent nucleotide "edition" and gene duplications to generate the 6

  20. Pseudo cluster randomization: a treatment allocation method to minimize contamination and selection bias.

    NARCIS (Netherlands)

    Borm, G.F.; Melis, R.J.F.; Teerenstra, S.; Peer, P.G.M.

    2005-01-01

    In some clinical trials, treatment allocation on a patient level is not feasible, and whole groups or clusters of patients are allocated to the same treatment. If, for example, a clinical trial is investigating the efficacy of various patient coaching methods and randomization is done on a patient

  1. Alcohol brief intervention for hospitalized veterans with hazardous drinking: protocol for a 3-arm randomized controlled efficacy trial

    OpenAIRE

    Broyles, Lauren M.; Wieland, Melissa E; Confer, Andrea L; DiNardo, Monica M; Kraemer, Kevin L; Hanusa, Barbara H.; Youk, Ada O.; GORDON, ADAM J; Sevick, Mary Ann

    2015-01-01

    Background Various hospital accreditation and quality assurance entities in the United States have approved and endorsed performance measures promoting alcohol brief intervention (BI) for hospitalized individuals who screen positive for unhealthy alcohol use, the spectrum of use ranging from hazardous use to alcohol use disorders. These performance measures have been controversial due to the limited and equivocal evidence for the efficacy of BI among hospitalized individuals. The few BI trial...

  2. A randomized controlled trial to determine the effects of music and relaxation interventions on perceived anxiety in hospitalized patients receiving orthopaedic or cancer treatment.

    Science.gov (United States)

    Eckhouse, Diane R; Hurd, Mary; Cotter-Schaufele, Susan; Sulo, Suela; Sokolowski, Malgorzata; Barbour, Laurel

    2014-01-01

    Nonpharmacological interventions, including combinations of music, education, coping skills, and relaxation techniques, have been found to have a positive effect on patients' perceived anxiety in many settings. However, few research studies have assessed and compared the effectiveness of music and relaxation interventions in reducing the anxiety levels of orthopaedic and oncology patients. We conducted a prospective, randomized, controlled study to examine the effectiveness of music and relaxation interventions on perceived anxiety during initial hospitalization for patients receiving orthopaedic or cancer care treatment at a Midwestern teaching hospital. This was a pre-test/post-test study design utilizing the State-Trait Anxiety Inventory. One hundred twelve patients were randomized into 3 study groups. Thirty-eight subjects (34%) were randomized in the music-focused relaxation group, 35 subjects (31%) in the music and video group, and 39 (35%) subjects in the control group. Fifty-seven (51%) were orthopaedic patients and 55 (49%) were oncology patients. Comparison of the 3 study groups showed no statistically significant differences with regard to patients' demographics. Although reduced anxiety levels were reported for all 3 groups postintervention, the differences were not statistically significant (p > .05). Also, there was no significant difference found between the perceived anxiety levels of patients admitted to the orthopaedic and oncology care units (p > .05). Finally, the results of the intragroup comparisons (regardless of the group assignment) showed a significant decrease in anxiety levels reported by all patients postintervention (p management of patient anxiety during hospitalization.

  3. GROWTH AND NUTRITIONAL STATUS OF THE FIRST SIX MONTHS OF LIFE AMONG SELECTED HOSPITALS--NAIROBI PROVINCE.

    Science.gov (United States)

    Lakati, A S; Makokha, A O; Binns, C W; Kombe, Y

    2013-11-01

    Exclusive breastfeeding for infants is recommended for the first six months for optimal health, development and growth. However, there is limited data on infant feeding practices and nutrition status of infants in Nairobi. To assess infant growth and nutritional status and compare with feeding practices in the first six months of life in selected hospitals, Nairobi Province. Prospective cohort design Five major hospitals in Nairobi namely; The Aga Khan, Pumwani Maternity, Mater Misercordiae, St Mary's Langata and Jamaa Hospitals. A sample of 692 mother-infant pairs were recruited at birth and followed up until six months. There was no direct experimental intervention, but there was observation of infant feeding practices, weight and height measurement was recorded every four weeks and determination of nutrition status of the infants for a period of six months. Nutritional status and infant feeding practices in the first six months. Slightly more than half (58.8%) of the mothers were formally employed and the rest were self employed. The mean age of the mothers was 28.3 ± 4.9 years. The mean income was KES 26,360 ± 34,696. The mean birth weight of infants was 3.24 ± 0.43 kg and 53.3% of all infants were male. Above 80% of infants were within normal weight based on weight for age Z-scores (WAZ) at 6, 10, 14 and 23 weeks. The prevalence of overweight based on WAZ was 9.5%, 11.6%, 11.9% and 11% at 6, 14, 19 and 23 weeks, respectively. There were no significant (P > 0.05) differences in WAZ between infants on different feeding methods. There was no significant difference in weight or length gain among children that were fully breastfed in comparison to those who were given infant formula or had mixed feeding. However, there was concern over the proportion of overweight infants, as the condition may lead to long term health problems.

  4. [Physical therapy intervention during hospitalization in patients with acute exacerbation of chronic obstructive pulmonary disease and pneumonia: A randomized clinical trial].

    Science.gov (United States)

    Martín-Salvador, Adelina; Colodro-Amores, Gloria; Torres-Sánchez, Irene; Moreno-Ramírez, M Paz; Cabrera-Martos, Irene; Valenza, Marie Carmen

    2016-04-01

    Respiratory infections involve not only hospitalization due to pneumonia, but also acute exacerbations of COPD (AECOPD). The objective of the present study was to evaluate the effectiveness of a physical therapy intervention during hospitalization in patients admitted due to community-acquired pneumonia (CAP) and AECOPD. Randomized clinical trial, 44 patients were randomized into 2 groups: a control group which received standard medical therapy (oxygen therapy and pharmacotherapy) and an experimental group that received standard treatment and a physical therapy intervention (breathing exercises, electrostimulation, exercises with elastic bands and relaxation). Between-groups analysis showed that after the intervention (experimental vs. control) significant differences were found in perceived dyspnoea (P=.041), and right and left quadriceps muscle strength (P=.008 and P=.010, respectively). In addition, the subscale of "domestic activities" of the functional ability related to respiratory symptoms questionnaire showed significant differences (P=.036). A physical therapy intervention during hospitalization in patients with AECOPD and CAP can generate skeletal muscle level gains that exceed the deterioration caused by immobilization during hospitalization. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  5. Antibacterial Effects of Origanum vulgare Essence Against Multidrug-Resistant Acinetobacter baumannii Isolated From Selected Hospitals of Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Saghi

    2015-02-01

    Full Text Available Background Infection due to Acinetobacter baumannii has become a significant challenge to modern healthcare systems. The rapid emergence and global dissemination of A. baumannii as a major nosocomial pathogen is remarkable and it demonstrates its successful adaptation to the 21st century hospital environment. Recent studies have discussed about essential oil of Origanum vulgare against a range of bacteria, including various species of Staphylococcus, Pseudomonas, Bacillus and Escherichia coli. Objectives The present study aimed to investigate the inhibitory effects O. vulgare essence against multidrug-resistant (MDR strains of A. baumannii from selected hospitals in Tehran, Iran. Materials and Methods This oil was obtained using the hydrodistillation method and analyzed by gas chromatography mass spectrography (GC/MS. The antimicrobial activity against MDR isolates was achieved using disc diffusion method and macro-broth dilution assay. Results Analysis of the essential oil revealed the presence of pulegone (68.59% piperitone (7.8%, piperitenone (7.8%, 1, 8-cineole (1.3%, and carvacrol (1.6% as the major components. The results showed a significant activity against MDR A. baumannii with inhibition zones and minimal inhibitory concentration values in the ranges of 7-15 mm and 20-35 µL/mL respectively. Conclusions This investigation showed that the essence oil of O. vulgare had a potent antimicrobial activity against MDR A. baumannii. Further research is required to evaluate the practical values of therapeutic applications.

  6. Evaluating the safety and efficacy of sodium-restricted/Dietary Approaches to Stop Hypertension diet after acute decompensated heart failure hospitalization: design and rationale for the Geriatric OUt of hospital Randomized MEal Trial in Heart Failure (GOURMET-HF).

    Science.gov (United States)

    Wessler, Jeffrey D; Maurer, Mathew S; Hummel, Scott L

    2015-03-01

    Heart failure (HF) is a major public health problem affecting predominantly older adults. Nonadherence to diet remains a significant contributor to acute decompensated HF (ADHF). The sodium-restricted Dietary Approaches to Stop Hypertension (DASH/SRD) eating plan reduces cardiovascular dysfunction that can lead to ADHF and is consistent with current HF guidelines. We propose that an intervention that promotes adherence to the DASH/SRD by home-delivering meals will be safe and improve health-related quality of life (QOL) in older adults after hospitalization for ADHF. This is a 3-center, randomized, single-blind, controlled trial of 12-week duration designed to determine the safety and efficacy of home-delivered DASH/SRD-compliant meals in older adults after discharge from ADHF hospitalization. Sixty-six subjects will be randomized in a 1:1 stratified fashion by gender and left ventricular ejection fraction (<50% vs ≥50%). Study subjects will receive either preprepared, home-delivered DASH/SRD-compliant meals or usual dietary advice for 4weeks after hospital discharge. Investigators will be blinded to group assignment, food diaries, and urinary electrolyte measurements until study completion. The primary efficacy end point is the change in the Kansas City Cardiomyopathy Questionnaire summary scores for health-related QOL from study enrollment to 4weeks postdischarge. Safety evaluation will focus on hypotension, renal insufficiency, and hyperkalemia. Exploratory end points include echocardiography, noninvasive vascular testing, markers of oxidative stress, and salt taste sensitivity. This randomized controlled trial will test the efficacy, feasibility, and safety of 4weeks of DASH/SRD after ADHF hospitalization. By testing a novel dietary intervention supported by multiple levels of evidence including preliminary data in outpatients with stable HF, we will address a critical evidence gap in the care of older patients with ADHF. If effective and safe, this

  7. Presence of psychoactive substances in oral fluid from randomly selected drivers in Denmark

    DEFF Research Database (Denmark)

    Simonsen, K. Wiese; Steentoft, A.; Hels, Tove

    2012-01-01

    This roadside study is the Danish part of the EU-project DRUID (Driving under the Influence of Drugs, Alcohol, and Medicines) and included three representative regions in Denmark. Oral fluid samples (n = 3002) were collected randomly from drivers using a sampling scheme stratified by time, season...... of narcotic drugs. It can be concluded that driving under the influence of drugs is as serious a road safety problem as drunk driving.......This roadside study is the Danish part of the EU-project DRUID (Driving under the Influence of Drugs, Alcohol, and Medicines) and included three representative regions in Denmark. Oral fluid samples (n = 3002) were collected randomly from drivers using a sampling scheme stratified by time, season...

  8. Presence of psychoactive substances in oral fluid from randomly selected drivers in Denmark

    DEFF Research Database (Denmark)

    Simonsen, Kirsten Wiese; Steentoft, Anni; Hels, Tove

    2012-01-01

    This roadside study is the Danish part of the EU-project DRUID (Driving under the Influence of Drugs, Alcohol, and Medicines) and included three representative regions in Denmark. Oral fluid samples (n = 3002) were collected randomly from drivers using a sampling scheme stratified by time, season....... It can be concluded that driving under the influence of drugs is as serious a road safety problem as drunk driving.......This roadside study is the Danish part of the EU-project DRUID (Driving under the Influence of Drugs, Alcohol, and Medicines) and included three representative regions in Denmark. Oral fluid samples (n = 3002) were collected randomly from drivers using a sampling scheme stratified by time, season...

  9. Feature selection and classification of mechanical fault of an induction motor using random forest classifier

    Directory of Open Access Journals (Sweden)

    Raj Kumar Patel

    2016-09-01

    Full Text Available Fault detection and diagnosis is the most important technology in condition-based maintenance (CBM system for rotating machinery. This paper experimentally explores the development of a random forest (RF classifier, a recently emerged machine learning technique, for multi-class mechanical fault diagnosis in bearing of an induction motor. Firstly, the vibration signals are collected from the bearing using accelerometer sensor. Parameters from the vibration signal are extracted in the form of statistical features and used as input feature for the classification problem. These features are classified through RF classifiers for four class problems. The prime objective of this paper is to evaluate effectiveness of random forest classifier on bearing fault diagnosis. The obtained results compared with the existing artificial intelligence techniques, neural network. The analysis of results shows the better performance and higher accuracy than the well existing techniques.

  10. Maternal education, prematurity and the risk of birth asphyxia in selected hospitals in Jakarta

    Directory of Open Access Journals (Sweden)

    Cicih Opitasari

    2016-03-01

    factors associated with birth asphyxia.Methods: This study was carried out in one government and one private hospitals in Jakarta. All medicalrecords of pregnant women who gave birth between January 1 to December 31 of 2011 were included.Birth asphyxia was defined as an Apgar score less then seven at one minute after birth. Logistic regressionwas used to analyze the risk factors related to birth asphyxia.Results: As many as 2777 samples out of 4191 were included for this analysis. The proportion of asphyxiain newborn babies was 6.5%. Compared with those who had high educated mothers, those who had loweducation level had 4.3-fold higher risk to have an asphyxiated baby [adjusted odds ratio (ORa = 4.31;P=0.000]. Meanwhile middle educated mothers had 3.3-fold higher risk to have birth asphyxia (ORa=3.31;P=0.000. In terms of gestasional age at birth, compared with those who had full term birth, those who hadpreterm birth had 3.1-fold higher risk to have birth asphyxia (ORa=3.07; P=0.000. Meanwhile, althoughnot significant, those who had postterm birth had 63% more risk (P=0.118 to have birth asphyxia.Conclusion: The mother who had lower and middle education levels as well as preterm babies had higherrisk for having birth asphyxia baby. (Health Science Journal of Indonesia 2015;6:111-5Keyword: maternal education, prematurity, birth asphyxia

  11. A multi-criteria decision-making approach to rank supplier selection criteria for hospital waste management: A case from Pakistan.

    Science.gov (United States)

    Ishtiaq, Palvisha; Khan, Sharfuddin Ahmed; Haq, Moiz-Ul

    2018-02-01

    To address environmental issues and cost effectiveness, waste management is necessary for healthcare facilities. Most importantly, segregation of hazardous and non-hazardous waste must be done as in many developing countries; disposal of both types of healthcare waste is done together, which is an unsafe practice. Waste generated in hospitals needs proper management to minimise hazards for patient and healthcare workers. At the same time, it is quite difficult for hospitals to find a systematic way to select appropriate suppliers for hospital waste management. Therefore, the purpose of this article is to identify, validate, and rank criteria that are essential for hospital waste management suppliers' selection. The analytical hierarchal process approach has been used and a survey from Pakistan's largest city (Karachi) has been considered to rank the most appropriate criteria that is necessary to select the supplier, especially in a developing country like Pakistan. Results show that waste management cost (45.5%) and suppliers' details (31.5%) are the top two main criteria for supplier selection; and storage cost (15.7%), waste handling cost (14.7%), and qualification of the suppliers (10.9%) are the top three most important overall sub-criteria for supplier selection for hospital waste management.

  12. Selective nerve root blocks vs. caudal epidural injection for single level prolapsed lumbar intervertebral disc - A prospective randomized study.

    Science.gov (United States)

    Singh, Sudhir; Kumar, Sanjiv; Chahal, Gaurav; Verma, Reetu

    2017-01-01

    Chronic lumbar radiculopathy has a lifetime prevalence of 5.3% in men and 3.7% in women. It usually resolves spontaneously, but up to 30% cases will have pronounced symptoms even after one year. A prospective randomized single-blind study was conducted to compare the efficacy of caudal epidural steroid injection and selective nerve root block in management of pain and disability in cases of lumbar disc herniation. Eighty patients with confirmed single-level lumbar disc herniation were equally divided in two groups: (a) caudal epidural and (b) selective nerve root block group, by a computer-generated random allocation method. The caudal group received three injections of steroid mixed with local anesthetics while selective nerve root block group received single injection of steroid mixed with local anesthetic agent. Patients were assessed for pain relief and reduction in disability. In SNRB group, pain reduced by more than 50% up till 6 months, while in caudal group more than 50% reduction of pain was maintained till 1 year. The reduction in ODI in SNRB group was 52.8% till 3 months, 48.6% till 6 months, and 46.7% at 1 year, while in caudal group the improvement was 59.6%, 64.6%, 65.1%, and 65.4% at corresponding follow-up periods, respectively. Caudal epidural block is an easy and safe method with better pain relief and improvement in functional disability than selective nerve root block. Selective nerve root block injection is technically more demanding and has to be given by a skilled anesthetist.

  13. A comparison of calorie and protein intake in hospitalized pediatric oncology patients dining with a caregiver versus patients dining alone: a randomized, prospective clinical trial.

    Science.gov (United States)

    Williams, Ruth; Hinds, Pamela S; Ke, Weiming; Hu, X Joan

    2004-01-01

    Hospitalization and cancer therapy can contribute to decreased food intake in children and adolescents with cancer, making it a challenge to meet their nutritional needs. The affect of hospitalization and the eating environment for pediatric oncology patients has not been studied very well, and the effect of altering the social aspect of mealtime for hospitalized pediatric oncology patients has not been studied at all. The authors conducted a randomized, prospective clinical trial to determine if hospitalized pediatric oncology patients consume more protein and calories when eating with a family member or when eating alone in their room at mealtime. All food and beverage intake was recorded for 3 consecutive days, and a food service satisfaction survey was completed on Day 3. Food records were analyzed for calorie and protein intake, and surveys were analyzed for patient/parent satisfaction. The study was completed by 200 hospitalized patients and their parent/caregiver. Overall, neither calorie nor protein intake differed significantly between the two groups, but patient/parent satisfaction was significantly higher in the group of patients who dined with their caregiver. By using analysis of variance, the authors found that ideal body weight and years of sickness were significantly associated with calorie and protein intake.

  14. Adherence to recommended lifestyle modifications and factors associated for hypertensive patients attending chronic follow-up units of selected public hospitals in Addis Ababa, Ethiopia

    Directory of Open Access Journals (Sweden)

    Tibebu A

    2017-02-01

    Full Text Available Abel Tibebu,1 Daniel Mengistu,2 Lemma Negesa1 1School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, 2School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia Introduction: One of the most prevalent noncommunicable diseases is hypertension (HTN. The availability of effective antihypertensive medications does not result in the expected outcomes in terms of controlling blood pressure. The rationale for these and other findings of uncontrolled HTN points toward poor adherence. The most neglected causes of uncontrolled HTN are unhealthy lifestyles. Few studies have been conducted to show the gap and magnitude of self-management adherence.Objective: This study aimed to assess adherence to recommended lifestyle modifications of hypertensive patients undergoing follow-up at chronic follow-up units of public health hospitals in Addis Ababa, Ethiopia, 2016.Methods: Institutional-based cross-sectional study was conducted in four public health hospitals which were selected by drawing lots. Systematic random sampling was used to select study subjects. The results of the descriptive statistics were expressed as percentages and frequencies. Associations between lifestyle modification and independent variables were analyzed using bivariate and multivariate logistic regression analysis. The study was conducted from February 15, 2016 to April 15, 2016.Results: The study included 404 respondents with a 97% response rate; 210 (52% were male and the mean age was 54.00±10.77 years. The respondents’ adherence to lifestyle modifications was 23%. The lifestyle adherence was found to be better in females, patients who had comorbidities, and had been knowledgeable about the disease and was poor among young adult respondents.Conclusion: The rates of adherence to lifestyle changes were generally found to be low. Educational sessions that especially focus on lifestyle

  15. Detection of Burkholderia pseudomallei in Sputum using Selective Enrichment Broth and Ashdown's Medium at Kampong Cham Provincial Hospital, Cambodia.

    Science.gov (United States)

    Nhem, Somary; Letchford, Joanne; Meas, Chea; Thann, Sovanndeth; McLaughlin, James C; Baron, Ellen Jo; West, T Eoin

    2014-01-01

    Melioidosis, infection caused by Burkholderia pseudomallei, is increasingly reported in Cambodia. We hypothesized that implementation of an enhanced sputum testing protocol in a provincial hospital diagnostic microbiology laboratory would increase detection of B. pseudomallei. We tested 241 sputum specimens that were deemed acceptable for culture, comparing culture in selective enrichment broth followed by sub-culture on Ashdown's medium to standard culture methods. Two specimens (0.8%) were positive for B. pseudomallei using the enhanced protocol whereas one specimen (0.4%) was positive using standard methods. Given the low numbers of positive specimens, we could not conclusively determine the utility of the enhanced sputum testing protocol. However, the ramifications of identification of  B. pseudomallei are substantial, and the benefit of the enhanced testing protocol may be more apparent in patients selected based on risk factors and clinical presentation. Promoting clinician awareness of the infection and encouraging utilization of diagnostic microbiology services are also likely to be important factors in facilitating identification of melioidosis.

  16. A study of relationship between the organizational justice and organizational citizenship behavior among nurses in selected hospitals of Isfahan University of Medical Sciences.

    Science.gov (United States)

    Yaghoubi, Maryam; Afshar, Mina; Javadi, Marzieh

    2012-09-01

    Numerous researches have been carried out to indicate that organizational justice (OJ) is a variable that anticipates many other variables in organizations, especially in hospitals. Organizational behavior (OCB) is one of the most important variables. We aimed to study the relationship between OJ and OCB of nurses in selected hospitals in Isfahan. This was a descriptive correlational study. The research was conducted among nurses of selected hospitals in Isfahan. Data were gathered using two questionnaires of OJ, and OCB. The t-test, chi-square, and Pearson correlation test were used to analyze the data through SPSS version 13. In general, the mean score (SD) of OJ among nurses was 41.2 (16.2) and the mean score of OCB was 57.7 (18). Finally, there was no significant relationship between OJ, civil virtue, and sportsmanship. There was a significant relationship between OJ, OCB, courtesy, and conscientiousness. As the scores of OCB and OJ among nurses were average in selected hospitals, the managers of the hospitals should improve the perception of justice among nurses. Today, organizations need efficient and expert workers to achieve their goals, and to grow and improve in all aspects. In fact, the efficiency and effectiveness of organizations depend on the staffs, especially in hospitals.

  17. A Study on the Challenges Faced By Health Systems in Establishing Risk Management in Selected Hospitals of Tehran University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Batoul Ahmadi

    2014-07-01

    Full Text Available Introduction: This study aimed to identify the challenges of risk management in the context of clinical governance in selected hospitals of Tehran University of Medical Sciences. Materials and Methods:This study was implemented in two phases: qualitative step and quantitative step (survey. The first step was conducted using in-depth interviews and the second was carried out through a survey by questionnaire. Data were collected in hospitals through in-depth interviews with hospitals managers and the experts involved in clinical governance who had been introduced by the hospital manager. All professionals affiliated with clinical governance in Baharloo, Firoozgar, Farabi, Shahid Rajai, Ziaeian, Motahari and Sina hospitals were selected. Results: 35 experts involved in clinical governance were interviewed. According to these experts, the main obstacles in hospital risk management were: Lack of an error reporting culture, exaggerated fear of the consequences, and physicians' lack of interest in this domain. High workloads in this area have led to a reduction in employees' contributions. Conclusion: Establishing clinical governance in health care organizations has had many benefits, such as improving patient care, increased level of patients' satisfaction, establishment of a risk management system, improvement in staff and health-care personnel cooperation, and achieving a more successful organizational management. Appropriate changes in the organizational culture are necessities for the successful establishment of risk management. Human and cultural obstacles that hinder the implementation of risk management in hospitals are evident; thus, major actions are necessary to implement risk management properly in a disciplined manner.

  18. Specific and selective probes for Staphylococcus aureus from phage-displayed random peptide libraries.

    Science.gov (United States)

    De Plano, Laura M; Carnazza, Santina; Messina, Grazia M L; Rizzo, Maria Giovanna; Marletta, Giovanni; Guglielmino, Salvatore P P

    2017-09-01

    Staphylococcus aureus is a major human pathogen causing health care-associated and community-associated infections. Early diagnosis is essential to prevent disease progression and to reduce complications that can be serious. In this study, we selected, from a 9-mer phage peptide library, a phage clone displaying peptide capable of specific binding to S. aureus cell surface, namely St.au9IVS5 (sequence peptide RVRSAPSSS).The ability of the isolated phage clone to interact specifically with S. aureus and the efficacy of its bacteria-binding properties were established by using enzyme linked immune-sorbent assay (ELISA). We also demonstrated by Western blot analysis that the most reactive and selective phage peptide binds a 78KDa protein on the bacterial cell surface. Furthermore, we observed selectivity of phage-bacteria-binding allowing to identify clinical isolates of S. aureus in comparison with a panel of other bacterial species. In order to explore the possibility of realizing a selective bacteria biosensor device, based on immobilization of affinity-selected phage, we have studied the physisorbed phage deposition onto a mica surface. Atomic Force Microscopy (AFM) was used to determine the organization of phage on mica surface and then the binding performance of mica-physisorbed phage to bacterial target was evaluated during the time by fluorescent microscopy. The system is able to bind specifically about 50% of S. aureus cells after 15' and 90% after one hour. Due to specificity and rapidness, this biosensing strategy paves the way to the further development of new cheap biosensors to be used in developing countries, as lab-on-chip (LOC) to detect bacterial agents in clinical diagnostics applications. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Selection of locations of knots for linear splines in random regression test-day models.

    Science.gov (United States)

    Jamrozik, J; Bohmanova, J; Schaeffer, L R

    2010-04-01

    Using spline functions (segmented polynomials) in regression models requires the knowledge of the location of the knots. Knots are the points at which independent linear segments are connected. Optimal positions of knots for linear splines of different orders were determined in this study for different scenarios, using existing estimates of covariance functions and an optimization algorithm. The traits considered were test-day milk, fat and protein yields, and somatic cell score (SCS) in the first three lactations of Canadian Holsteins. Two ranges of days in milk (from 5 to 305 and from 5 to 365) were taken into account. In addition, four different populations of Holstein cows, from Australia, Canada, Italy and New Zealand, were examined with respect to first lactation (305 days) milk only. The estimates of genetic and permanent environmental covariance functions were based on single- and multiple-trait test-day models, with Legendre polynomials of order 4 as random regressions. A differential evolution algorithm was applied to find the best location of knots for splines of orders 4 to 7 and the criterion for optimization was the goodness-of-fit of the spline covariance function. Results indicated that the optimal position of knots for linear splines differed between genetic and permanent environmental effects, as well as between traits and lactations. Different populations also exhibited different patterns of optimal knot locations. With linear splines, different positions of knots should therefore be used for different effects and traits in random regression test-day models when analysing milk production traits.

  20. A randomized, controlled trial of the effectiveness of nebulized therapy with epinephrine compared with albuterol and saline in infants hospitalized for acute viral bronchiolitis.

    Science.gov (United States)

    Patel, Hema; Platt, Robert W; Pekeles, Gary S; Ducharme, Francine M

    2002-12-01

    In previously well infants hospitalized with acute viral bronchiolitis, the effectiveness of repeated nebulized therapy with epinephrine (EPI) was compared with treatment with albuterol (ALB) or saline placebo (PLAC). In this randomized, double-blind, parallel-group, controlled trial, infants received study nebulizations every 1 to 6 hours and were assessed twice daily by the research team. The primary outcome was length of hospital stay (LOS). Secondary outcomes included the time from admission until the infant had normal hydration, oxygenation, and minimal respiratory distress. A total of 149 infants were randomized; 50 were allocated to receive racemic EPI, 51 were given ALB, and 48 received PLAC. Baseline characteristics and pre-enrollment symptoms, signs, and therapy were similar between groups. There were no group differences in the primary outcome measure, mean LOS (hours)(+/- SD): EPI = 59.8 (62), ALB = 61.4 (54), and PLAC = 63.3 (47); P =.95 by intent-to-treat analysis. Group differences were not statistically significant in any of the secondary outcomes. There were no group differences in the effectiveness of therapy for infants hospitalized with bronchiolitis. Based on these results, we do not recommend routine use of either nebulized EPI or ALB in this patient group.

  1. Patient-Specific CT-Based Instrumentation versus Conventional Instrumentation in Total Knee Arthroplasty: A Prospective Randomized Controlled Study on Clinical Outcomes and In-Hospital Data

    Directory of Open Access Journals (Sweden)

    Andrzej Kotela

    2015-01-01

    Full Text Available Total knee arthroplasty (TKA is a frequently performed procedure in orthopaedic surgery. Recently, patient-specific instrumentation was introduced to facilitate correct positioning of implants. The aim of this study was to compare the early clinical results of TKA performed with patient-specific CT-based instrumentation and conventional technique. A prospective, randomized controlled trial on 112 patients was performed between January 2011 and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients who received the Signature CT-based implant positioning system, and the control group consisted of 60 patients with conventional instrumentation. Clinical outcomes were evaluated with the KSS scale, WOMAC scale, and VAS scales to assess knee pain severity and patient satisfaction with the surgery. Specified in-hospital data were recorded. Patients were followed up for 12 months. At one year after surgery, there were no statistically significant differences between groups with respect to clinical outcomes and in-hospital data, including operative time, blood loss, hospital length of stay, intraoperative observations, and postoperative complications. Further high-quality investigations of various patient-specific systems and longer follow-up may be helpful in assessing their utility for TKA.

  2. A Randomized Controlled Trial of Cognitive Debiasing Improves Assessment and Treatment Selection for Pediatric Bipolar Disorder

    Science.gov (United States)

    Jenkins, Melissa M.; Youngstrom, Eric A.

    2015-01-01

    Objective This study examined the efficacy of a new cognitive debiasing intervention in reducing decision-making errors in the assessment of pediatric bipolar disorder (PBD). Method The study was a randomized controlled trial using case vignette methodology. Participants were 137 mental health professionals working in different regions of the US (M=8.6±7.5 years of experience). Participants were randomly assigned to a (1) brief overview of PBD (control condition), or (2) the same brief overview plus a cognitive debiasing intervention (treatment condition) that educated participants about common cognitive pitfalls (e.g., base-rate neglect; search satisficing) and taught corrective strategies (e.g., mnemonics, Bayesian tools). Both groups evaluated four identical case vignettes. Primary outcome measures were clinicians’ diagnoses and treatment decisions. The vignette characters’ race/ethnicity was experimentally manipulated. Results Participants in the treatment group showed better overall judgment accuracy, p < .001, and committed significantly fewer decision-making errors, p < .001. Inaccurate and somewhat accurate diagnostic decisions were significantly associated with different treatment and clinical recommendations, particularly in cases where participants missed comorbid conditions, failed to detect the possibility of hypomania or mania in depressed youths, and misdiagnosed classic manic symptoms. In contrast, effects of patient race were negligible. Conclusions The cognitive debiasing intervention outperformed the control condition. Examining specific heuristics in cases of PBD may identify especially problematic mismatches between typical habits of thought and characteristics of the disorder. The debiasing intervention was brief and delivered via the Web; it has the potential to generalize and extend to other diagnoses as well as to various practice and training settings. PMID:26727411

  3. Genome-wide association data classification and SNPs selection using two-stage quality-based Random Forests.

    Science.gov (United States)

    Nguyen, Thanh-Tung; Huang, Joshua; Wu, Qingyao; Nguyen, Thuy; Li, Mark

    2015-01-01

    Single-nucleotide polymorphisms (SNPs) selection and identification are the most important tasks in Genome-wide association data analysis. The problem is difficult because genome-wide association data is very high dimensional and a large portion of SNPs in the data is irrelevant to the disease. Advanced machine learning methods have been successfully used in Genome-wide association studies (GWAS) for identification of genetic variants that have relatively big effects in some common, complex diseases. Among them, the most successful one is Random Forests (RF). Despite of performing well in terms of prediction accuracy in some data sets with moderate size, RF still suffers from working in GWAS for selecting informative SNPs and building accurate prediction models. In this paper, we propose to use a new two-stage quality-based sampling method in random forests, named ts-RF, for SNP subspace selection for GWAS. The method first applies p-value assessment to find a cut-off point that separates informative and irrelevant SNPs in two groups. The informative SNPs group is further divided into two sub-groups: highly informative and weak informative SNPs. When sampling the SNP subspace for building trees for the forest, only those SNPs from the two sub-groups are taken into account. The feature subspaces always contain highly informative SNPs when used to split a node at a tree. This approach enables one to generate more accurate trees with a lower prediction error, meanwhile possibly avoiding overfitting. It allows one to detect interactions of multiple SNPs with the diseases, and to reduce the dimensionality and the amount of Genome-wide association data needed for learning the RF model. Extensive experiments on two genome-wide SNP data sets (Parkinson case-control data comprised of 408,803 SNPs and Alzheimer case-control data comprised of 380,157 SNPs) and 10 gene data sets have demonstrated that the proposed model significantly reduced prediction errors and outperformed

  4. Role of selective V2-receptor-antagonism in septic shock: a randomized, controlled, experimental study

    OpenAIRE

    Rehberg, Sebastian; Ertmer, Christian; Lange, Matthias; Morelli, Andrea; Whorton, Elbert; Strohhäcker, Anne-Katrin; Dünser, Martin Wolfgang; Lipke, Erik; Kampmeier, Tim G; Aken, Hugo; Traber, Daniel L; Westphal, Martin

    2010-01-01

    ABSTRACT : INTRODUCTION : V2-receptor (V2R) stimulation potentially aggravates sepsis-induced vasodilation, fluid accumulation and microvascular thrombosis. Therefore, the present study was performed to determine the effects of a first-line therapy with the selective V2R-antagonist (Propionyl1-D-Tyr(Et)2-Val4-Abu6-Arg8,9)-Vasopressin on cardiopulmonary hemodynamics and organ function vs. the mixed V1aR/V2R-agonist arginine vasopressin (AVP) or placebo in an established ovine model of septic s...

  5. Does physical exercise improve ADL capacities in people over 65 years with moderate or severe dementia hospitalized in an acute psychiatric setting? A multisite randomized clinical trial.

    Science.gov (United States)

    Bürge, Elisabeth; Berchtold, André; Maupetit, Christine; Bourquin, Nathalie M-P; von Gunten, Armin; Ducraux, Daniel; Zumbach, Serge; Peeters, Anne; Kuhne, Nicolas

    2017-02-01

    Several studies on the effect of physical exercise on activities of daily living (ADL) for people with dementia exist; yet, data concerning the specific context of acute psychiatric hospitals remain scant. This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward. A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals. Participants were randomly allocated to either an experimental group (EG) or a control group (CG). Members of the EG received 20 physical exercise sessions (strengthening, balance, and walking) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency, but without physical exercise. The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention, and two weeks later. Hundred and sixty patients completed the program. Characteristics of participants of both groups were similar at the inception of the study. The mean ADL score of EG decreased slightly over time, whereas that of the CG significantly decreased compared to initial scores. Overall differences between groups were not significant; however, significant differences were found for mobility-related items. ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization. An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores.

  6. Information seeking behaviour of pregnant women in selected ...

    African Journals Online (AJOL)

    This study sought to ascertain the information seeking behaviour of pregnant women in selected hospitals of Ibadan Metropolis. The study adopted the survey design. The study's population encompassed of 1900 pregnant women in selected hospitals. Proportional random sampling technique was used to draw samples ...

  7. Conflicts of Interest, Selective Inertia, and Research Malpractice in Randomized Clinical Trials: An Unholy Trinity.

    Science.gov (United States)

    Berger, Vance W

    2015-08-01

    Recently a great deal of attention has been paid to conflicts of interest in medical research, and the Institute of Medicine has called for more research into this important area. One research question that has not received sufficient attention concerns the mechanisms of action by which conflicts of interest can result in biased and/or flawed research. What discretion do conflicted researchers have to sway the results one way or the other? We address this issue from the perspective of selective inertia, or an unnatural selection of research methods based on which are most likely to establish the preferred conclusions, rather than on which are most valid. In many cases it is abundantly clear that a method that is not being used in practice is superior to the one that is being used in practice, at least from the perspective of validity, and that it is only inertia, as opposed to any serious suggestion that the incumbent method is superior (or even comparable), that keeps the inferior procedure in use, to the exclusion of the superior one. By focusing on these flawed research methods we can go beyond statements of potential harm from real conflicts of interest, and can more directly assess actual (not potential) harm.

  8. Participant-selected music and physical activity in older adults following cardiac rehabilitation: a randomized controlled trial.

    Science.gov (United States)

    Clark, Imogen N; Baker, Felicity A; Peiris, Casey L; Shoebridge, Georgie; Taylor, Nicholas F

    2017-03-01

    To evaluate effects of participant-selected music on older adults' achievement of activity levels recommended in the physical activity guidelines following cardiac rehabilitation. A parallel group randomized controlled trial with measurements at Weeks 0, 6 and 26. A multisite outpatient rehabilitation programme of a publicly funded metropolitan health service. Adults aged 60 years and older who had completed a cardiac rehabilitation programme. Experimental participants selected music to support walking with guidance from a music therapist. Control participants received usual care only. The primary outcome was the proportion of participants achieving activity levels recommended in physical activity guidelines. Secondary outcomes compared amounts of physical activity, exercise capacity, cardiac risk factors, and exercise self-efficacy. A total of 56 participants, mean age 68.2 years (SD = 6.5), were randomized to the experimental ( n = 28) and control groups ( n = 28). There were no differences between groups in proportions of participants achieving activity recommended in physical activity guidelines at Week 6 or 26. Secondary outcomes demonstrated between-group differences in male waist circumference at both measurements (Week 6 difference -2.0 cm, 95% CI -4.0 to 0; Week 26 difference -2.8 cm, 95% CI -5.4 to -0.1), and observed effect sizes favoured the experimental group for amounts of physical activity (d = 0.30), exercise capacity (d = 0.48), and blood pressure (d = -0.32). Participant-selected music did not increase the proportion of participants achieving recommended amounts of physical activity, but may have contributed to exercise-related benefits.

  9. Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial

    Science.gov (United States)

    Machado, Aline dos Santos; Pires-Neto, Ruy Camargo; Carvalho, Maurício Tatsch Ximenes; Soares, Janice Cristina; Cardoso, Dannuey Machado; de Albuquerque, Isabella Martins

    2017-01-01

    ABSTRACT Objective: To evaluate the effects that passive cycling exercise, in combination with conventional physical therapy, have on peripheral muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients admitted to the ICU of a tertiary care university hospital. Methods: This was a randomized clinical trial involving 38 patients (≥ 18 years of age) on mechanical ventilation who were randomly divided into two groups: control (n = 16), receiving conventional physical therapy; and intervention (n = 22), receiving conventional physical therapy and engaging in passive cycling exercise five days per week. The mean age of the patients was 46.42 ± 16.25 years, and 23 were male. The outcomes studied were peripheral muscle strength, as measured by the Medical Research Council scale, duration of mechanical ventilation, and length of hospital stay. Results: There was a significant increase in peripheral muscle strength (baseline vs. final) in both groups (control: 40.81 ± 7.68 vs. 45.00 ± 6.89; and intervention: 38.73 ± 11.11 vs. 47.18 ± 8.75; p < 0.001 for both). However, the range of increase in strength was higher in the intervention group than in the control group (8.45 ± 5.20 vs. 4.18 ± 2.63; p = 0.005). There were no significant differences between the groups in terms of duration of mechanical ventilation or length of hospital stay. Conclusions: The results suggest that the performance of continuous passive mobilization on a cyclical basis helps to recover peripheral muscle strength in ICU patients. (ClinicalTrials.gov Identifier: NCT01769846 [http://www.clinicaltrials.gov/]) PMID:28538781

  10. Does nebulized epinephrine improve the efficacy of hypertonic saline solution in the treatment of hospitalized moderate acute bronchiolitis? A double blind, randomized clinical trial.

    Science.gov (United States)

    Flores-González, Jose Carlos; Dominguez-Coronel, Maria Teresa; Matamala Morillo, Miguel Angel; Aragón Ramírez, Miriam; García Ortega, Rosa María; Dávila Corrales, Francisco Javier; García Palacios, Maria Victoria; Perez Guerrero, Juan Jesus; García García, Laura; Lechuga Sancho, Alfonso María

    2016-04-01

    Nebulized 3% hypertonic saline solution (HSS 3%) has proven to reduce hospital stay in infants with acute bronchiolitis, as compared with nebulized physiological saline solutions. There are no studies assessing the effectiveness of nebulized epinephrine in patients treated with HSS 3%. The aim of this study was to compare the length of stay (LOS) in hospitalized patients treated with HSS 3% with placebo vs. HSS 3% with epinephrine. Secondarily we aimed to assess the effectiveness and safety of both treatments. We performed a prospective, randomized, double-blind, parallel-group study, including infants hospitalized for moderate acute bronchiolitis. Both groups received standard life support and were randomly treated with nebulized HSS 3% (7 mL) with either placebo 3 mL or epinephrine 3 mL. Nebulizations were initially administered every four hours and this interval was modified according to the patient's response. Sixty-four infants were included, 32 patients in each group. No statistically significant differences were found between the two groups (P=0.948) in length of stay, disease severity, SatO2, respiratory rate or heart rate. On the third day of hospitalization, severity and respiratory rate in the HSS 3%+E presented a non statistically significant trend to an earlier improvement, (P=0.063 and P=0.096 repectively). No adverse events occurred. Four patients (two from each group) required transfer to the pediatric intensive care unit. With a third of the final estimated sample, we find a trend to an earlier clinical recovery in the epinephrine group, even though no statistical significant differences in LOS were found. The study needs to be continued until the total sample is recruited.

  11. Implementing an evidence-based computerized decision support system to improve patient care in a general hospital: the CODES study protocol for a randomized controlled trial.

    Science.gov (United States)

    Moja, Lorenzo; Polo Friz, Hernan; Capobussi, Matteo; Kwag, Koren; Banzi, Rita; Ruggiero, Francesca; González-Lorenzo, Marien; Liberati, Elisa Giulia; Mangia, Massimo; Nyberg, Peter; Kunnamo, Ilkka; Cimminiello, Claudio; Vighi, Giuseppe; Grimshaw, Jeremy; Bonovas, Stefanos

    2016-07-07

    Computerized decision support systems (CDSSs) are information technology-based software that provide health professionals with actionable, patient-specific recommendations or guidelines for disease diagnosis, treatment, and management at the point-of-care. These messages are intelligently filtered to enhance the health and clinical care of patients. CDSSs may be integrated with patient electronic health records (EHRs) and evidence-based knowledge. We designed a pragmatic randomized controlled trial to evaluate the effectiveness of patient-specific, evidence-based reminders generated at the point-of-care by a multi-specialty decision support system on clinical practice and the quality of care. We will include all the patients admitted to the internal medicine department of one large general hospital. The primary outcome is the rate at which medical problems, which are detected by the decision support software and reported through the reminders, are resolved (i.e., resolution rates). Secondary outcomes are resolution rates for reminders specific to venous thromboembolism (VTE) prevention, in-hospital all causes and VTE-related mortality, and the length of hospital stay during the study period. The adoption of CDSSs is likely to increase across healthcare systems due to growing concerns about the quality of medical care and discrepancy between real and ideal practice, continuous demands for a meaningful use of health information technology, and the increasing use of and familiarity with advanced technology among new generations of physicians. The results of our study will contribute to the current understanding of the effectiveness of CDSSs in primary care and hospital settings, thereby informing future research and healthcare policy questions related to the feasibility and value of CDSS use in healthcare systems. This trial is seconded by a specialty trial randomizing patients in an oncology setting (ONCO-CODES). ClinicalTrials.gov, https://clinicaltrials.gov/ct2

  12. Content analysis of a stratified random selection of JVME articles: 1974-2004.

    Science.gov (United States)

    Olson, Lynne E

    2011-01-01

    A content analysis was performed on a random sample (N = 168) of 25% of the articles published in the Journal of Veterinary Medical Education (JVME) per year from 1974 through 2004. Over time, there were increased numbers of authors per paper, more cross-institutional collaborations, greater prevalence of references or endnotes, and lengthier articles, which could indicate a trend toward publications describing more complex or complete work. The number of first authors that could be identified as female was greatest for the most recent time period studied (2000-2004). Two different categorization schemes were created to assess the content of the publications. The first categorization scheme identified the most frequently published topics as admissions, descriptions of courses, the effect of changing teaching methods, issues facing the profession, and examples of uses of technology. The second categorization scheme identified the subset of articles that described medical education research on the basis of the purpose of the research, which represented only 14% of the sample articles (24 of 168). Of that group, only three of 24, or 12%, represented studies based on a firm conceptual framework that could be confirmed or refuted by the study's results. The results indicate that JVME is meeting its broadly based mission and that publications in the veterinary medical education literature have features common to publications in medicine and medical education.

  13. Capturing the Flatness of a peer-to-peer lending network through random and selected perturbations

    Science.gov (United States)

    Karampourniotis, Panagiotis D.; Singh, Pramesh; Uparna, Jayaram; Horvat, Emoke-Agnes; Szymanski, Boleslaw K.; Korniss, Gyorgy; Bakdash, Jonathan Z.; Uzzi, Brian

    Null models are established tools that have been used in network analysis to uncover various structural patterns. They quantify the deviance of an observed network measure to that given by the null model. We construct a null model for weighted, directed networks to identify biased links (carrying significantly different weights than expected according to the null model) and thus quantify the flatness of the system. Using this model, we study the flatness of Kiva, a large international crownfinancing network of borrowers and lenders, aggregated to the country level. The dataset spans the years from 2006 to 2013. Our longitudinal analysis shows that flatness of the system is reducing over time, meaning the proportion of biased inter-country links is growing. We extend our analysis by testing the robustness of the flatness of the network in perturbations on the links' weights or the nodes themselves. Examples of such perturbations are event shocks (e.g. erecting walls) or regulatory shocks (e.g. Brexit). We find that flatness is unaffected by random shocks, but changes after shocks target links with a large weight or bias. The methods we use to capture the flatness are based on analytics, simulations, and numerical computations using Shannon's maximum entropy. Supported by ARL NS-CTA.

  14. Benefits of Selected Physical Exercise Programs in Detention: A Randomized Controlled Study

    Directory of Open Access Journals (Sweden)

    Claudia Battaglia

    2013-10-01

    Full Text Available The aim of the study was to determine which kind of physical activity could be useful to inmate populations to improve their health status and fitness levels. A repeated measure design was used to evaluate the effects of two different training protocols on subjects in a state of detention, tested pre- and post-experimental protocol.Seventy-five male subjects were enrolled in the studyand randomly allocated to three groups: the cardiovascular plus resistance training protocol group (CRT (n = 25; mean age 30.9 ± 8.9 years,the high-intensity strength training protocol group (HIST (n = 25; mean age 33.9 ± 6.8 years, and a control group (C (n = 25; mean age 32.9 ± 8.9 years receiving no treatment. All subjects underwent a clinical assessmentandfitness tests. MANOVA revealed significant multivariate effects on group (p < 0.01 and group-training interaction (p < 0.05. CRT protocol resulted the most effective protocol to reach the best outcome in fitness tests. Both CRT and HIST protocols produced significant gains in the functional capacity (cardio-respiratory capacity and cardiovascular disease risk decrease of incarcerated males. The significant gains obtained in functional capacity reflect the great potential of supervised exercise interventions for improving the health status of incarcerated people.

  15. Appraisal of HIV Counseling and Testing Services Provided for Pregnant Women in Selected Government Hospitals in Ibadan Metropolis, Nigeria

    Directory of Open Access Journals (Sweden)

    Olanipekun Asiyanbola

    2016-04-01

    Full Text Available HIV counseling and testing (HCT is a critical gateway to treatment, care, and support services. For pregnant women, it is to access prevention of mother-to-child-transmission (PMTCT services. However, not much has been done to appraise this service from the perspective of the recipients in Nigeria. This study documents the appraisal of the HCT services received at the antenatal care (ANC services in three government hospitals in Ibadan, Nigeria, from the perspectives of pregnant women. Data were collected using focus group discussion guide among purposively selected 40 (21 primigravida and 19 multigravida pregnant women. Observation and inventory checklists were used to collect data on procedures and basic requirements of HCT. Content analysis was used to analyze the data. Participants were neither counseled nor given opportunity to voluntarily participate in HCT services as it was made compulsory before accessing ANC. Test results were reportedly handed over directly to participants without post-test counseling. Observation of HCT procedure showed that guidelines for counseling were not strictly adhered to. Inventory of facilities, staff, and materials revealed inadequate staffing, lack of a dedicated counseling room, and inadequate antiretroviral drugs and test kits. The HCT services as provided for pregnant women are fraught with procedural inadequacies. Training and supervision of health care workers as well as provision of resources are needed to address the situation.

  16. Reduced plasma aldosterone concentrations in randomly selected patients with insulin-dependent diabetes mellitus.

    LENUS (Irish Health Repository)

    Cronin, C C

    2012-02-03

    Abnormalities of the renin-angiotensin system have been reported in patients with diabetes mellitus and with diabetic complications. In this study, plasma concentrations of prorenin, renin, and aldosterone were measured in a stratified random sample of 110 insulin-dependent (Type 1) diabetic patients attending our outpatient clinic. Fifty-four age- and sex-matched control subjects were also examined. Plasma prorenin concentration was higher in patients without complications than in control subjects when upright (geometric mean (95% confidence intervals (CI): 75.9 (55.0-105.6) vs 45.1 (31.6-64.3) mU I-1, p < 0.05). There was no difference in plasma prorenin concentration between patients without and with microalbuminuria and between patients without and with background retinopathy. Plasma renin concentration, both when supine and upright, was similar in control subjects, in patients without complications, and in patients with varying degrees of diabetic microangiopathy. Plasma aldosterone was suppressed in patients without complications in comparison to control subjects (74 (58-95) vs 167 (140-199) ng I-1, p < 0.001) and was also suppressed in patients with microvascular disease. Plasma potassium was significantly higher in patients than in control subjects (mean +\\/- standard deviation: 4.10 +\\/- 0.36 vs 3.89 +\\/- 0.26 mmol I-1; p < 0.001) and plasma sodium was significantly lower (138 +\\/- 4 vs 140 +\\/- 2 mmol I-1; p < 0.001). We conclude that plasma prorenin is not a useful early marker for diabetic microvascular disease. Despite apparently normal plasma renin concentrations, plasma aldosterone is suppressed in insulin-dependent diabetic patients.

  17. A Permutation Importance-Based Feature Selection Method for Short-Term Electricity Load Forecasting Using Random Forest

    Directory of Open Access Journals (Sweden)

    Nantian Huang

    2016-09-01

    Full Text Available The prediction accuracy of short-term load forecast (STLF depends on prediction model choice and feature selection result. In this paper, a novel random forest (RF-based feature selection method for STLF is proposed. First, 243 related features were extracted from historical load data and the time information of prediction points to form the original feature set. Subsequently, the original feature set was used to train an RF as the original model. After the training process, the prediction error of the original model on the test set was recorded and the permutation importance (PI value of each feature was obtained. Then, an improved sequential backward search method was used to select the optimal forecasting feature subset based on the PI value of each feature. Finally, the optimal forecasting feature subset was used to train a new RF model as the final prediction model. Experiments showed that the prediction accuracy of RF trained by the optimal forecasting feature subset was higher than that of the original model and comparative models based on support vector regression and artificial neural network.

  18. Optimizing polypharmacy among elderly hospital patients with chronic diseases--study protocol of the cluster randomized controlled POLITE-RCT trial.

    Science.gov (United States)

    Löffler, Christin; Drewelow, Eva; Paschka, Susanne D; Frankenstein, Martina; Eger, Julia; Jatsch, Lisa; Reisinger, Emil C; Hallauer, Johannes F; Drewelow, Bernd; Heidorn, Karen; Schröder, Helmut; Wollny, Anja; Kundt, Günther; Schmidt, Christian; Altiner, Attila

    2014-10-06

    Treatment of patients with multimorbidity is challenging. A rational reduction of long-term drugs can lead to decreased mortality, less acute hospital treatment, and a reduction of costs. Simplification of drug treatment schemes is also related to higher levels of patient satisfaction and adherence. The POLITE-RCT trial will test the effectiveness of an intervention aiming at reducing the number of prescribed long-term drugs among multimorbid and chronically ill patients. The intervention focuses on the interface between primary and secondary health care and includes a pharmacist-based, patient-centered medication review prior to the patient's discharge from hospital. The POLITE-RCT trial is a cluster randomized controlled trial. Two major secondary health care providers of Mecklenburg-Western Pomerania, Germany, take part in the study. Clusters are wards of both medical centers. All wards where patients with chronic diseases and multimorbidity are regularly treated will be included. Patients aged 65+ years who take five or more prescribed long-term drugs and who are likely to spend at least 5 days in the participating hospitals will be recruited and included consecutively. Cluster-randomization takes place after a six-month baseline data collection period. Patients of the control group receive care as usual. The independent two main primary outcomes are (1) health-related quality of life (EQ-5D) and (2) the difference in the number of prescribed long-term pharmaceutical agents between intervention and control group. The secondary outcomes are appropriateness of prescribed medication (PRISCUS list, Beers Criteria, MAI), patient satisfaction (TSQM), patient empowerment (PEF-FB-9), patient autonomy (IADL), falls, re-hospitalization, and death. The points of measurement are at admission to (T0) and discharge from hospital (T1) as well as 6 and 12 months after discharge from the hospital (T2 and T3). In 42 wards, 1,626 patients will be recruited. In case of positive

  19. Protein-enriched familiar foods and drinks improve protein intake of hospitalized older patients: A randomized controlled trial

    NARCIS (Netherlands)

    Beelen, J.; Vasse, Emmelyne; Janssen, N.; Janse, A.; Roos, de N.M.; Groot, de C.P.G.M.

    2017-01-01

    Background & aims Adequate protein intake is important in preventing and treating undernutrition. Hospitalized older patients are recommended to consume 1.2–1.5 g of protein per kg body weight per day (g/kg/d) but most of them fail to do so. Therefore, we investigated whether a range of newly

  20. Effectiveness of a selective, personality-targeted prevention program for adolescent alcohol use and misuse: a cluster randomized controlled trial.

    Science.gov (United States)

    Conrod, Patricia J; O'Leary-Barrett, Maeve; Newton, Nicola; Topper, Lauren; Castellanos-Ryan, Natalie; Mackie, Clare; Girard, Alain

    2013-03-01

    Selective school-based alcohol prevention programs targeting youth with personality risk factors for addiction and mental health problems have been found to reduce substance use and misuse in those with elevated personality profiles. To report 24-month outcomes of the Teacher-Delivered Personality-Targeted Interventions for Substance Misuse Trial (Adventure trial) in which school staff were trained to provide interventions to students with 1 of 4 high-risk (HR) profiles: anxiety sensitivity, hopelessness, impulsivity, and sensation seeking and to examine the indirect herd effects of this program on the broader low-risk (LR) population of students who were not selected for intervention. Cluster randomized controlled trial. Secondary schools in London, United Kingdom. A total of 1210 HR and 1433 LR students in the ninth grade (mean [SD] age, 13.7 [0.33] years). Schools were randomized to provide brief personality-targeted interventions to HR youth or treatment as usual (statutory drug education in class). Participants were assessed for drinking, binge drinking, and problem drinking before randomization and at 6-monthly intervals for 2 years. Two-part latent growth models indicated long-term effects of the intervention on drinking rates (β = -0.320, SE = 0.145, P = .03) and binge drinking rates (β = -0.400, SE = 0.179, P = .03) and growth in binge drinking (β = -0.716, SE = 0.274, P = .009) and problem drinking (β = -0.452, SE = 0.193, P = .02) for HR youth. The HR youth were also found to benefit from the interventions during the 24-month follow-up on drinking quantity (β = -0.098, SE = 0.047, P = .04), growth in drinking quantity (β = -0.176, SE = 0.073, P = .02), and growth in binge drinking frequency (β = -0.183, SE = 0.092, P = .047). Some herd effects in LR youth were observed, specifically on drinking rates (β = -0.259, SE = 0.132, P = .049) and growth of binge drinking (β = -0.244, SE = 0.073, P = .001), during the 24-month follow-up. Findings further

  1. Preference option randomized design (PORD) for comparative effectiveness research: Statistical power for testing comparative effect, preference effect, selection effect, intent-to-treat effect, and overall effect.

    Science.gov (United States)

    Heo, Moonseong; Meissner, Paul; Litwin, Alain H; Arnsten, Julia H; McKee, M Diane; Karasz, Alison; McKinley, Paula; Rehm, Colin D; Chambers, Earle C; Yeh, Ming-Chin; Wylie-Rosett, Judith

    2017-01-01

    Comparative effectiveness research trials in real-world settings may require participants to choose between preferred intervention options. A randomized clinical trial with parallel experimental and control arms is straightforward and regarded as a gold standard design, but by design it forces and anticipates the participants to comply with a randomly assigned intervention regardless of their preference. Therefore, the randomized clinical trial may impose impractical limitations when planning comparative effectiveness research trials. To accommodate participants' preference if they are expressed, and to maintain randomization, we propose an alternative design that allows participants' preference after randomization, which we call a "preference option randomized design (PORD)". In contrast to other preference designs, which ask whether or not participants consent to the assigned intervention after randomization, the crucial feature of preference option randomized design is its unique informed consent process before randomization. Specifically, the preference option randomized design consent process informs participants that they can opt out and switch to the other intervention only if after randomization they actively express the desire to do so. Participants who do not independently express explicit alternate preference or assent to the randomly assigned intervention are considered to not have an alternate preference. In sum, preference option randomized design intends to maximize retention, minimize possibility of forced assignment for any participants, and to maintain randomization by allowing participants with no or equal preference to represent random assignments. This design scheme enables to define five effects that are interconnected with each other through common design parameters-comparative, preference, selection, intent-to-treat, and overall/as-treated-to collectively guide decision making between interventions. Statistical power functions for testing

  2. Single-chain lipopeptide vaccines for the induction of virus-specific cytotoxic T cell responses in randomly selected populations.

    Science.gov (United States)

    Gras-Masse, H

    2001-12-01

    Effective vaccine development is now taking advantage of the rapidly accumulating information concerning the molecular basis of a protective immune response. Analysts and medicinal chemists have joined forces with immunologists and taken up the clear challenge of identifying immunologically active structural elements and synthesizing them in pure, reproducible forms. Current literature reveals the growing interest for extremely reductionist approaches aiming at producing totally synthetic vaccines that would be fully defined at the molecular level and particularly safe. The sequential information contained in these formulations tends to be minimized to those epitopes which elicit neutralizing antibodies, or cell-mediated responses. In the following review, we describe some of our results in developing fully synthetic, clinically acceptable lipopeptide vaccines for inducing cytotoxic T lymphocytes (CTL) responses in randomly selected populations.

  3. Selecting Optimal Random Forest Predictive Models: A Case Study on Predicting the Spatial Distribution of Seabed Hardness

    Science.gov (United States)

    Li, Jin; Tran, Maggie; Siwabessy, Justy

    2016-01-01

    Spatially continuous predictions of seabed hardness are important baseline environmental information for sustainable management of Australia’s marine jurisdiction. Seabed hardness is often inferred from multibeam backscatter data with unknown accuracy and can be inferred from underwater video footage at limited locations. In this study, we classified the seabed into four classes based on two new seabed hardness classification schemes (i.e., hard90 and hard70). We developed optimal predictive models to predict seabed hardness using random forest (RF) based on the point data of hardness classes and spatially continuous multibeam data. Five feature selection (FS) methods that are variable importance (VI), averaged variable importance (AVI), knowledge informed AVI (KIAVI), Boruta and regularized RF (RRF) were tested based on predictive accuracy. Effects of highly correlated, important and unimportant predictors on the accuracy of RF predictive models were examined. Finally, spatial predictions generated using the most accurate models were visually examined and analysed. This study confirmed that: 1) hard90 and hard70 are effective seabed hardness classification schemes; 2) seabed hardness of four classes can be predicted with a high degree of accuracy; 3) the typical approach used to pre-select predictive variables by excluding highly correlated variables needs to be re-examined; 4) the identification of the important and unimportant predictors provides useful guidelines for further improving predictive models; 5) FS methods select the most accurate predictive model(s) instead of the most parsimonious ones, and AVI and Boruta are recommended for future studies; and 6) RF is an effective modelling method with high predictive accuracy for multi-level categorical data and can be applied to ‘small p and large n’ problems in environmental sciences. Additionally, automated computational programs for AVI need to be developed to increase its computational efficiency and

  4. Selecting Optimal Random Forest Predictive Models: A Case Study on Predicting the Spatial Distribution of Seabed Hardness.

    Directory of Open Access Journals (Sweden)

    Jin Li

    Full Text Available Spatially continuous predictions of seabed hardness are important baseline environmental information for sustainable management of Australia's marine jurisdiction. Seabed hardness is often inferred from multibeam backscatter data with unknown accuracy and can be inferred from underwater video footage at limited locations. In this study, we classified the seabed into four classes based on two new seabed hardness classification schemes (i.e., hard90 and hard70. We developed optimal predictive models to predict seabed hardness using random forest (RF based on the point data of hardness classes and spatially continuous multibeam data. Five feature selection (FS methods that are variable importance (VI, averaged variable importance (AVI, knowledge informed AVI (KIAVI, Boruta and regularized RF (RRF were tested based on predictive accuracy. Effects of highly correlated, important and unimportant predictors on the accuracy of RF predictive models were examined. Finally, spatial predictions generated using the most accurate models were visually examined and analysed. This study confirmed that: 1 hard90 and hard70 are effective seabed hardness classification schemes; 2 seabed hardness of four classes can be predicted with a high degree of accuracy; 3 the typical approach used to pre-select predictive variables by excluding highly correlated variables needs to be re-examined; 4 the identification of the important and unimportant predictors provides useful guidelines for further improving predictive models; 5 FS methods select the most accurate predictive model(s instead of the most parsimonious ones, and AVI and Boruta are recommended for future studies; and 6 RF is an effective modelling method with high predictive accuracy for multi-level categorical data and can be applied to 'small p and large n' problems in environmental sciences. Additionally, automated computational programs for AVI need to be developed to increase its computational efficiency and

  5. Implementation Intentions as a Strategy to Increase the Notification Rate of Potential Ocular Tissue Donors by Nurses: A Clustered Randomized Trial in Hospital Settings

    Directory of Open Access Journals (Sweden)

    Frédéric Douville

    2014-01-01

    Full Text Available Aim. The purpose of this study is to evaluate the impact, among nurses in hospital settings, of a questionnaire-based implementation intentions intervention on notification of potential ocular tissue donors to donation stakeholders. Methods. This randomized intervention was clustered at the level of hospital departments with two study arms: questionnaire-based implementation intentions intervention and control. In the intervention group, nurses were asked to plan specific actions if faced with a number of barriers when reporting potential ocular donors. The primary outcome was the potential ocular tissue donors’ notification rate before and after the intervention. Analysis was based on a generalized linear model with an identity link and a binomial distribution. Results. We compared outcomes in 26 departments from 5 hospitals, 13 departments per condition. The implementation intentions intervention did not significantly increase the notification rate of ocular tissue donors (intervention: 23.1% versus control: 21.1%; χ2=1.14, 2; P=0.56. Conclusion. A single and brief implementation intentions intervention among nurses did not modify the notification rate of potential ocular tissue donors to donation stakeholders. Low exposure to the intervention was a major challenge in this study. Further studies should carefully consider a multicomponent intervention to increase exposure to this type of intervention.

  6. [A randomized controlled trial of preoperative oral immunonutrition in patients undergoing surgery for colorectal cancer: hospital stay and health care costs].

    Science.gov (United States)

    Manzanares Campillo, María Del Carmen; Martín Fernández, Jesús; Amo Salas, Mariano; Casanova Rituerto, Daniel

    The use of enteral formulas with immunonutrients in patients with gastrointestinal malignancies susceptible to surgery can reduce postoperative morbidity, at the expense of reduced infectious complications, with the consequent reduction in hospital stay and health care costs. Prospective randomized study. 84 patients operated on a scheduled basis for resectable colorectal cancer were recruited. In the group YES IN Impact © Oral was administered for 8 days (3 sachets a day), compared with the NOT IN group who did not receive it. 40.5% (17) patients without immunonutrition suffered infectious complications vs. 33.3% (14) of YES IN. In patients with rectal cancer NOT IN, 50% (8) suffered minor infectious complications (p=.028). In each group (YES IN, NOT IN, colon and rectal cancer) when infectious complications were observed, the variables total hospital stay and costs doubled, with significant differences. These variables showed higher values in the group NOT IN compared with those who received immunonutrition, although these differences were not statistically significant. NOT IN patients suffered infectious complications more frequently than YES IN, with significant results in the subgroup of patients with rectal cancer. The total hospital stay and costs were slightly higher in the group not supplemented, doubling in each category significantly (YES IN, NOT IN, colon and rectal cancer), when infectious complications were observed. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  7. Comparison of the Effect of Plastic Cover and Blanket on Body Temperature of Preterm Infants Hospitalized in NICU: Randomized Clinical Trial.

    Science.gov (United States)

    Valizadeh, Leila; Mahallei, Majid; Safaiyan, Abdolrasoul; Ghorbani, Fatemeh; Peyghami, Maryam

    2017-06-01

    Introduction: Preterm infants are unable to regulate their body temperature and there are insufficient research evidences on different kinds of covers for hospitalized preterm infants; therefore, the present study was conducted with the aim of comparing the effects of plastic and blanket covers on the body temperature of preterm infants under radiant warmer. Methods: This randomized cross-over clinical trial was carried out upon 80 infants with the gestational age of 28-30 weeks and birth weight of 800- 1250 gr who were in Neonatal Intensive Care Unit on the second day of their hospitalization. The study lasted for two days. In group 1, the plastic cover was used during the first day of the study while the blankets were used during the second day. Infants' heads were kept out of the cover and coated with a hat. In group 2, the plastic cover was used during the first day of the study while the blanket was used during second day. Digital thermometer was used to measure infants' axillary temperature. The data was analyzed using SPSS ver 13 and MiniTab software. Descriptive statistics, (Mean (SE), 95%CI) and inferential statistics (Repeated measurement and ANCOVA tests) were used. Results: The mean body temperature of the infants in the group covered with the plastic was calculated to be higher and the warmer was set on low temperature. Conclusion: Using plastic cover during the first few days of hospitalization in NICU resulted in regulation of preterm infants' body temperature.

  8. Impact of drug reconciliation at discharge and communication between hospital and community pharmacists on drug-related problems: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Pourrat, Xavier; Roux, Clarisse; Bouzige, Brigitte; Garnier, Valérie; Develay, Armelle; Allenet, Benoit; Fraysse, Martial; Halimi, Jean-Michel; Grassin, Jacqueline; Giraudeau, Bruno

    2014-06-30

    Patients are at risk of drug-related problems (DRPs) at transition points during hospitalization. The community pharmacist (CP) is often the first healthcare professional patients visit after discharge. CPs lack sufficient information about the patient and so they may be unable to identify problems in medications, which may lead to dispensing the wrong drugs or dosage, and/or giving wrong information. We aim to assess the impact of a complex intervention comprising of medication reconciliation performed at discharge by a hospital pharmacist (HP) with communication between the HP and CP on DRPs during the seven days following discharge. The study is a cluster randomized crossover trial involving 46 care units (each unit corresponding to a cluster) in 22 French hospitals during two consecutive 14-day periods, randomly assigned as 'experimental' or 'control' (usual care) periods. We will recruit patients older than 18 years of age and visiting the same CP for at least three months. We will exclude patients with a hospital length of stay of more than 21 days, who do not return home or those in palliative care. During the experimental period, the HP will perform a medications reconciliation that will be communicated to the patient. The HP will inform the patient's CP about the patient's drug therapy (modification in home medication, acute drugs prescribed, nonprescription treatments, and/or lab results). The primary outcome will be a composite outcome of any kind of drug misuse during the seven days following discharge assessed at day seven (±2) post-discharge by a pharmacist in charge of the study who will contact both patients and CPs by phone. The secondary outcome will be unplanned hospitalizations assessed by phone contact at day 35 (±5) after discharge. We plan to recruit 1,176 patients. This study will assess the impact of a reconciliation of medications performed at patient discharge followed by communication between the HP and the patient's CP. It will allow

  9. Efficacy of a family intervention program for prevention of hospitalization in patients with schizophrenia. A naturalistic multicenter controlled and randomized study in Spain.

    Science.gov (United States)

    Mayoral, Fermín; Berrozpe, Adela; de la Higuera, Jesús; Martinez-Jambrina, Juan José; de Dios Luna, Juan; Torres-Gonzalez, Francisco

    2015-01-01

    According to most relevant guidelines, family psycho-educational interventions are considered to be one the most effective psychosocial treatments for people with schizophrenia. The main outcome measure in controlled and randomized studies has been prevention of relapses and admissions, and encouragement of compliance, although some questions remain about its applicability and results in clinical practice. The aim of study was to evaluate the efficacy and implementation of a single family psychoeducational intervention in 'real' conditions for people diagnosed with schizophrenia. A total of 88 families were randomized in two groups. The family intervention group received a 12 months psychoeducational treatment, and the other group followed normal standard treatment. Assessments were made at baseline, at 12 and at 18 months. The main outcome measure was hospitalization, and secondary outcome measures were clinical condition (BPRS-E) and social disability (DAS-II). A total of 71 patients finished the study (34 family intervention group and 37 control group). Patients who received family intervention reduced the risk of hospitalization by 40% (P = .4018; 95%CI: 0.1833-0.6204). Symptomatology improved significantly at 12 months (P = .4018; 95%CI: 0.1833-0.6204), but not at 18 months (P = .4018; 95%CI: 0.1833-0.6204). Social disability was significantly reduced in the family intervention group at 12 months and 18 months. Family psychoeducational intervention reduces hospitalization risk and improves clinical condition and social functioning of people with schizophrenia. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.

  10. Evaluating the Effect of Hospital and Insurance Type on the Risk of 1-Year Mortality of Very Low Birth Weight Infants: Controlling for Selection Bias

    Science.gov (United States)

    Ounpraseuth, Songthip; Gauss, C. Heath; Bronstein, Janet; Lowery, Curtis; Nugent, Richard; Hall, Richard

    2012-01-01

    OBJECTIVES We examined the effect of hospital type and medical coverage on the risk of 1-year mortality of very low birth weight (VLBW) infants while adjusting for possible selection bias. METHODS The study population was limited to singleton live birth infants having birth weight between 500 and 1,500 grams with no congenital anomalies who were born in Arkansas hospitals between 2001 and 2007. Propensity score (PS) matching and PS covariate adjustment were used to mitigate selection bias. Additionally, a conventional multivariable logistic regression model was used for comparison purposes. RESULTS Generally, all three analytical approaches provided consistent results in terms of the estimated relative risk, absolute risk reduction, and the number needed to treat (NNT). Using the PS matching method, VLBW infants delivered at a hospital with a neonatal intensive care unit (NICU) were associated with a 35% relative decrease (95% bootstrap CI: 18.5% – 48.9%) in the risk of 1-year mortality as compared to those infants delivered at non-NICU hospitals. Furthermore, our results showed that on average, 16 VLBW infants (95% bootstrap CI: 11 – 32), would need to be delivered at a hospital with an NICU to prevent one additional death at one year. However, there was not a difference in the risk of 1-year mortality between VLBW infants born to Medicaid-insured versus non-Medicaid-insured women. CONCLUSIONS Estimated relative risk of infant mortality was significantly lower for births that occurred in hospitals with an NICU; therefore, greater efforts should be made to deliver VLBW neonates in an NICU hospital. PMID:22422056

  11. The Integration of Marketing/Distribution and Hospitality/Recreation Career Exploration Curriculum into Selected Career Exploration Classes, Spring, 1977.

    Science.gov (United States)

    Barnes, Evelyn S.

    A study was designed to evaluate the implementation of career exploration in marketing/distribution and hospitality/recreation through courses offered in one junior high and four senior high school classes in Wisconsin in 1977. The marketing/distribution and hospitality/recreation curriculum was incorporated in distributive education, American…

  12. K-Ras(G12D)-selective inhibitory peptides generated by random peptide T7 phage display technology.

    Science.gov (United States)

    Sakamoto, Kotaro; Kamada, Yusuke; Sameshima, Tomoya; Yaguchi, Masahiro; Niida, Ayumu; Sasaki, Shigekazu; Miwa, Masanori; Ohkubo, Shoichi; Sakamoto, Jun-Ichi; Kamaura, Masahiro; Cho, Nobuo; Tani, Akiyoshi

    2017-03-11

    Amino-acid mutations of Gly 12 (e.g. G12D, G12V, G12C) of V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (K-Ras), the most promising drug target in cancer therapy, are major growth drivers in various cancers. Although over 30 years have passed since the discovery of these mutations in most cancer patients, effective mutated K-Ras inhibitors have not been marketed. Here, we report novel and selective inhibitory peptides to K-Ras(G12D). We screened random peptide libraries displayed on T7 phage against purified recombinant K-Ras(G12D), with thorough subtraction of phages bound to wild-type K-Ras, and obtained KRpep-2 (Ac-RRCPLYISYDPVCRR-NH 2 ) as a consensus sequence. KRpep-2 showed more than 10-fold binding- and inhibition-selectivity to K-Ras(G12D), both in SPR analysis and GDP/GTP exchange enzyme assay. K D and IC 50 values were 51 and 8.9 nM, respectively. After subsequent sequence optimization, we successfully generated KRpep-2d (Ac-RRRRCPLYISYDPVCRRRR-NH 2 ) that inhibited enzyme activity of K-Ras(G12D) with IC 50  = 1.6 nM and significantly suppressed ERK-phosphorylation, downstream of K-Ras(G12D), along with A427 cancer cell proliferation at 30 μM peptide concentration. To our knowledge, this is the first report of a K-Ras(G12D)-selective inhibitor, contributing to the development and study of K-Ras(G12D)-targeting drugs. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Promotion of Cholera Awareness Among Households of Cholera Patients: A Randomized Controlled Trial of the Cholera-Hospital-Based-Intervention-for-7 Days (CHoBI7) Intervention.

    Science.gov (United States)

    Saif-Ur-Rahman, K M; Parvin, Tahmina; Bhuyian, Sazzadul Islam; Zohura, Fatema; Begum, Farzana; Rashid, Mahamud-Ur; Biswas, Shwapon Kumar; Sack, David; Sack, R Bradley; Monira, Shirajum; Alam, Munirul; Shaly, Nusrat Jahan; George, Christine Marie

    2016-12-07

    Previous studies have demonstrated that household contacts of cholera patients are highly susceptible to cholera infections for a 7-day period after the presentation of the index patient in the hospital. However, there is no standard of care to prevent cholera transmission in this high-risk population. Furthermore, there is limited information available on awareness of cholera transmission and prevention among cholera patients and their household contacts. To initiate a standard of care for this high-risk population, we developed the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7), which delivers a handwashing with soap and water treatment intervention to household contacts during the time they spend with the admitted cholera patient in the hospital and reinforces these messages through home visits. To test CHoBI7, we conducted a randomized controlled trial among 302 intervention cholera patient household members and 302 control cholera patient household members in Dhaka, Bangladesh. In this study, we evaluated the effectiveness of the CHoBI7 intervention in increasing awareness of cholera transmission and prevention, and the key times for handwashing with soap. We observed a significant increase in cholera knowledge score in the intervention arm compared with the control arm at both the 1-week follow-up {score coefficient = 2.34 (95% confidence interval [CI] = 1.96, 2.71)} and 6 to 12-month follow-up period (score coefficient = 1.59 [95% CI = 1.05, 2.13]). This 1-week hospital- and home-based intervention led to a significant increase in knowledge of cholera transmission and prevention which was sustained 6 to 12 months post-intervention. These findings suggest that the CHoBI7 intervention presents a promising approach to increase cholera awareness among this high-risk population. © The American Society of Tropical Medicine and Hygiene.

  14. Knowledge of healthcare professionals about medication errors in hospitals

    OpenAIRE

    Abdel-Latif, Mohamed M. M.

    2016-01-01

    Context: Medication errors are the most common types of medical errors in hospitals and leading cause of morbidity and mortality among patients. Aims: The aim of the present study was to assess the knowledge of healthcare professionals about medication errors in hospitals. Settings and Design: A self-administered questionnaire was distributed to randomly selected healthcare professionals in eight hospitals in Madinah, Saudi Arabia. Subjects and Methods: An 18-item survey was designed and comp...

  15. The systematic early integration of palliative care into multidisciplinary oncology care in the hospital setting (IPAC), a randomized controlled trial: the study protocol.

    Science.gov (United States)

    Vanbutsele, Gaëlle; Van Belle, Simon; De Laat, Martine; Surmont, Veerle; Geboes, Karen; Eecloo, Kim; Pardon, Koen; Deliens, Luc

    2015-12-15

    Previous studies in the US and Canada, have shown the positive impact of early palliative care programs for advanced cancer patients on quality of life (QoL) and even survival time. There has been a lack of similar research in Europe. In order to generalize the findings from the US and Canada research on a larger scale, similar studies are needed in different countries with different care settings. The aim of this paper is to describe the research protocol of a randomized controlled trial, situated in Flanders, Belgium, evaluating the effect of systematic early integration of palliative care in standard oncology care. A randomized controlled trial will be conducted as follows: 182 patients with advanced cancer will be recruited from the departments of Medical Oncology, Digestive Oncology and Thoracic Oncology of the Ghent University Hospital. The trial will randomize patients to either systematic early integration of palliative care in standard oncology care or standard oncology care alone. Patients and informal caregivers will be asked to fill out questionnaires on QoL, mood, illness understanding and satisfaction with care at baseline, 12 weeks and every six weeks thereafter. Other outcome measures are end-of-life care decisions and overall survival time. This trial will be the first randomized controlled trial in the Belgian health care setting to evaluate the effect of systematic early integration of palliative care for advanced cancer patients. The results will enable us to evaluate whether systematic early integration of palliative care has positive effects on QoL, mood and patient illness-understanding and which components of the intervention contribute to these effects. Clinicaltrials.gov Identifier: NCT01865396 , registered 24(th) of May, 2013.

  16. Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial.

    Science.gov (United States)

    George, Christine Marie; Jung, Danielle S; Saif-Ur-Rahman, K M; Monira, Shirajum; Sack, David A; Mahamud-ur Rashid; Mahmud, Md Toslim; Mustafiz, Munshi; Rahman, Zillur; Bhuyian, Sazzadul Islam; Winch, Peter J; Leontsini, Elli; Perin, Jamie; Begum, Farzana; Zohura, Fatema; Biswas, Shwapon; Parvin, Tahmina; Sack, R Bradley; Alam, Munirul

    2016-02-01

    Diarrhea is the second leading cause of death in children under 5 years of age globally. The time patients and caregivers spend at a health facility for severe diarrhea presents the opportunity to deliver water, sanitation, and hygiene (WASH) interventions. We recently developed Cholera-Hospital-Based Intervention for 7 days (CHoBI7), a 1-week hospital-based handwashing with soap and water treatment intervention, for household members of cholera patients. To investigate if this intervention could lead to sustained WASH practices, we conducted a follow-up evaluation of 196 intervention household members and 205 control household members enrolled in a randomized controlled trial of the CHoBI7 intervention 6 to 12 months post-intervention. Compared with the control arm, the intervention arm had four times higher odds of household members' handwashing with soap at a key time during 5-hour structured observation (odds ratio [OR]: 4.71, 95% confidence interval [CI]: 2.61, 8.49) (18% versus 50%) and a 41% reduction in households in the World Health Organization very high-risk category for stored drinking water (OR: 0.38, 95% CI: 0.15, 0.96) (58% versus 34%) 6 to 12 months post-intervention. Furthemore, 71% of observed handwashing with soap events in the intervention arm involved the preparation and use of soapy water, which was promoted during the intervention, compared to 9% of control households. These findings demonstrate that the hospital-based CHoBI7 intervention can lead to significant increases in handwashing with soap practices and improved stored drinking water quality 6 to 12 months post-intervention. © The American Society of Tropical Medicine and Hygiene.

  17. Knowledge of common problems of newborn among primi mothers admitted in a selected hospital for safe confinement

    Directory of Open Access Journals (Sweden)

    K C Leena

    2014-01-01

    Full Text Available Background: Among the almost 3.9 million newborn deaths that occur worldwide, about 30% occur in India. Children are our future and utmost precious resources. After birth the health of the child depends upon the health care practice adopted by the family, especially by the mothers. Information about neonatal problems and newborn care practices will help in reducing mortality and morbidity during the neonatal period. This study was conducted to identify the knowledge of primi mothers with regard to the common problems of normal neonates. Materials and Methods: This descriptive study was carried out among the mothers of neonates in the Maternity Unit of a Medical College Hospital in Mangalore. A pretested structured knowledge questionnaire was used to collect information from 60 primi mothers, who were admitted for safe confinement for a one-month period. Results: The findings of the study show that the majority, that is, 27 (45% of the primi mothers had a good knowledge of all the areas such as vomiting, regurgitation, diaper rash, umbilical cord infection, fever, constipation, and diarrhea. About 20 (33.3% had very good knowledge and about 13 (21.67% had an average level of knowledge on the common problems of newborns. Knowledge about vomiting was average among 34 (56.67%, poor in 21 (35%, and good in five (8.33%. Knowledge about diaper rash was average among 36 (60%, good among 21 (35%, and poor among three (5%. Knowledge on umbilical cord infection was average in 29 (48.33%, good in 27 (45%, and poor in 4 (6.67%. Knowledge on fever was good in 38 (63.33%, average in 19 (31.66%, and poor in three (5%. Knowledge on constipation and diarrhea were average in 38 (63.34%, good in 11 (18.33%, and poor in 11 (18.33%. No association was found between the knowledge of primi mothers and selected baseline variables, such as, age, education, religion, occupation, type of family or area of dwelling. Conclusion: The study concludes that there is a need to

  18. Ranking of the Causes of Medication Errors in the Viewpoints of Nurses in Selected Hospitals Affiliated With Yazd University of Medical Sciences, Iran

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    Roohollah Askari

    2017-09-01

    Methods: A cross-sectional study was conducted on 220 nurses working in educational hospitals affiliated to Yazd University of Medical Sciences (Shahid Sadoughi, Shahid Rahnemoon and Afshar Hospitals. Stratified random sampling was used. Required data was gathered by Gladstone questionnaire. Data analysis was done through SPSS 16. Results: The most common causes of medication errors were the failure to match the patients' names with ordered drugs, the ill-considered and unreadable nature of the physicians' orders and the nominal similarity of drugs. Failure to match the patients' names with ordered drugs (3.45 ± 2.85 and the incorrect setting of the infusion device by the nurse (8.81 ± 2.57 had the highest and lowest scores from the viewpoints of nurses. Conclusion: Establishing and implementing electronic drug prescription, in service training for improving nurses' pharmacological knowledge, identifying the main types and causes of drug errors, the teaching of proper prescribing techniques are needed.

  19. Postcards in Persia: A Twelve to Twenty-four Month Follow-up of a Randomized Controlled Trial for Hospital-Treated Deliberate Self-Poisoning.

    Science.gov (United States)

    Hassanian-Moghaddam, Hossein; Sarjami, Saeedeh; Kolahi, Ali-Asghar; Lewin, Terry; Carter, Gregory

    2017-01-02

    This study reports the outcomes, during follow-up, of a low-cost postcard intervention in a Randomized Control Trial of hospital-treated self-poisoning (n = 2300). The intervention was 9 postcards over 12 months (plus usual treatment) versus usual treatment. Three binary endpoints at 12-24 months (n = 2001) were: any suicidal ideation, suicide attempt, or self-cutting. There was a significant reduction in any suicidal ideation (RRR 0.20 CI 95% 0.13-0.27), (NNT 8, 6-13), and any suicide attempt (RRR 0.31, 0.06-0.50), (NNT 35, 19-195), in this non-western population. However, there was no effect on self-cutting (RRR -0.01, -1.05-0.51). Sustained, brief contact by mail may reduce some forms of suicidal behavior in self-poisoning patients during the post intervention phase.

  20. Selectivity of Chemoresistive Sensors Made of Chemically Functionalized Carbon Nanotube Random Networks for Volatile Organic Compounds (VOC

    Directory of Open Access Journals (Sweden)

    Jean-François Feller

    2014-01-01

    Full Text Available Different grades of chemically functionalized carbon nanotubes (CNT have been processed by spraying layer-by-layer (sLbL to obtain an array of chemoresistive transducers for volatile organic compound (VOC detection. The sLbL process led to random networks of CNT less conductive, but more sensitive to vapors than filtration under vacuum (bucky papers. Shorter CNT were also found to be more sensitive due to the less entangled and more easily disconnectable conducting networks they are making. Chemical functionalization of the CNT’ surface is changing their selectivity towards VOC, which makes it possible to easily discriminate methanol, chloroform and tetrahydrofuran (THF from toluene vapors after the assembly of CNT transducers into an array to make an e-nose. Interestingly, the amplitude of the CNT transducers’ responses can be enhanced by a factor of five (methanol to 100 (chloroform by dispersing them into a polymer matrix, such as poly(styrene (PS, poly(carbonate (PC or poly(methyl methacrylate (PMMA. COOH functionalization of CNT was found to penalize their dispersion in polymers and to decrease the sensors’ sensitivity. The resulting conductive polymer nanocomposites (CPCs not only allow for a more easy tuning of the sensors’ selectivity by changing the chemical nature of the matrix, but they also allow them to adjust their sensitivity by changing the average gap between CNT (acting on quantum tunneling in the CNT network. Quantum resistive sensors (QRSs appear promising for environmental monitoring and anticipated disease diagnostics that are both based on VOC analysis.

  1. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial

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    Liao LY

    2015-08-01

    Full Text Available Lin-Yu Liao,1,2 Kuei-Min Chen,2 Wei-Sheng Chung,3 Jung-Yien Chien4 1Department of Nursing, Chest Hospital, Ministry of Health and Welfare, Rende District, Tainan, 2College of Nursing, Kaohsiung Medical University, Sanmin District, Kaohsiung, 3Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, 4Department of Medicine, Chest Hospital, Ministry of Health and Welfare, Rende District, Tainan, Taiwan Clinical trials identifier: NCT02329873 Background: Acute exacerbation (AE of COPD is characterized by a sudden worsening of COPD symptoms. Previous studies have explored the effectiveness of respiratory rehabilitation for patients with COPD; however, no training program specific to acute exacerbation in elderly patients or unstable periods during hospitalization has been developed.Objective: To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD.Methods: A randomized control trial was conducted. Pretest and posttest evaluations of 61 elderly inpatients with AECOPD (experimental group n=30; control group n=31 were performed. The experimental group received respiratory rehabilitation exercise training twice a day, 10–30 minutes per session for 4 days. The clinical parameters (dyspnea, cough, exercise tolerance, and sputum expectoration were assessed at the baseline and at the end of the fourth day.Results: All participants (median age =70 years, male =60.70%, and peak expiratory flow 140 L completed the study. In the patients of the experimental group, dyspnea and cough decreased and exercise tolerance and sputum expectoration increased significantly compared with those of the patients in the control group (all P<0.05. Within-group comparisons revealed that the dyspnea, cough, and exercise tolerance significantly improved in the experimental group by the end of the fourth

  2. Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition–Heart Failure (BEAT-HF) Randomized Clinical Trial

    Science.gov (United States)

    Ong, Michael K.; Romano, Patrick S.; Edgington, Sarah; Aronow, Harriet U.; Auerbach, Andrew D.; Black, Jeanne T.; De Marco, Teresa; Escarce, Jose J.; Evangelista, Lorraine S.; Hanna, Barbara; Ganiats, Theodore G.; Greenberg, Barry H.; Greenfield, Sheldon; Kaplan, Sherrie H.; Kimchi, Asher; Liu, Honghu; Lombardo, Dawn; Mangione, Carol M.; Sadeghi, Bahman; Sadeghi, Banafsheh; Sarrafzadeh, Majid; Tong, Kathleen; Fonarow, Gregg C.

    2016-01-01

    Importance It remains unclear whether telemonitoring approaches provide benefits for patients with heart failure (HF) after hospitalization. Objective To evaluate the effectiveness of a care transition intervention using remote patient monitoring in reducing 180-day all-cause readmissions among a broad population of older adults hospitalized with HF. Design, Setting, and Participants We randomized 1437 patients hospitalized for HF between October 12, 2011, and September 30, 2013, to the intervention arm (715 patients) or to the usual care arm (722 patients) of the Better Effectiveness After Transition–Heart Failure (BEAT-HF) study and observed them for 180 days. The dates of our study analysis were March 30, 2014, to October 1, 2015. The setting was 6 academic medical centers in California. Participants were hospitalized individuals 50 years or older who received active treatment for decompensated HF. Interventions The intervention combined health coaching telephone calls and telemonitoring. Telemonitoring used electronic equipment that collected daily information about blood pressure, heart rate, symptoms, and weight. Centralized registered nurses conducted telemonitoring reviews, protocolized actions, and telephone calls. Main outcomes and measures The primary outcome was readmission for any cause within 180 days after discharge. Secondary outcomes were all-cause readmission within 30 days, all-cause mortality at 30 and 180 days, and quality of life at 30 and 180 days. Results Among 1437 participants, the median age was 73 years. Overall, 46.2% (664 of 1437) were female, and 22.0% (316 of 1437) were African American. The intervention and usual care groups did not differ significantly in readmissions for any cause 180 days after discharge, which occurred in 50.8% (363 of 715) and 49.2% (355 of 722) of patients, respectively (adjusted hazard ratio, 1.03; 95% CI, 0.88-1.20; P = .74). In secondary analyses, there were no significant differences in 30-day

  3. USE OF THE PROBIOTIC Lactobacillus reuteri DSM 17938 IN THE PREVENTION OF ANTIBIOTIC-ASSOCIATED INFECTIONS IN HOSPITALIZED BULGARIAN CHILDREN: A RANDOMIZED, CONTROLLED TRIAL

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    Miglena Georgieva

    2015-10-01

    Full Text Available Objective: To evaluate the effectiveness of Lactobacillus reuteri DSM 17938 for the prevention of antibiotic-associated diarrhoea and Clostridium difficile-related infections in hospitalized children in a Bulgarian hospital. Study design: Children (n=100, aged 3 to 12 years admitted to the hospital for acute infections were enrolled in a randomized, double- blind, placebo-controlled trial. They were assigned to receive either a probiotic supplement containing 1 x 108 CFU Lactobacillus reuteri DSM 17938 in the form of one chewable tablet once per day (n=49 (BioGaia AB, Stockholm, Sweden or placebo (n=48. The probiotic or placebo was taken 2 hours after lunch each day, during the entire period of antibiotic treatment at the hospital and for additional 7 days. Results: Data from 97 children were included in the final analysis. The incidence of diarrhoea (defined as at least 3 loose or watery stools per day in a 48-hour period that occurred during or up to 21 days after cessation of antibiotic treatment was unexpectedly low in both groups - L. reuteri (n=1 versus placebo (n=1: 2,04 vs. 2,1 per 100 (p>0,05, risk ratio 1,02, 95% CI 0,7-1,4. L reuteri DSM 17938 did not significantly affect the incidence or severity of AAD diarrhoea and Clostridium difficile infection. We found unusually high colonisation rate of non-symptomatic C. difficile measured by toxin-specific ELISA. There was no difference between the probiotic and placebo groups for any of the other secondary outcomes (i.e., incidence of mild diarrhoea, frequency of stool samples positive for C. difficile toxin A and B at the beginning and at the end of study period, frequencies of other gastrointestinal symptoms in the same study period (p<0,05. No adverse events were reported. Conclusion: Due to the low incidence of antibiotic-associated diarrhoea in both groups, no conclusion can be made on the efficacy of L. reuteri DSM 17938 on AAD in hospitalized Bulgarian children. The probiotic did not

  4. Effects of pharmacists' interventions on appropriateness of prescribing and evaluation of the instruments' (MAI, STOPP and STARTs' ability to predict hospitalization--analyses from a randomized controlled trial.

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    Ulrika Gillespie

    Full Text Available Appropriateness of prescribing can be assessed by various measures and screening instruments. The aims of this study were to investigate the effects of pharmacists' interventions on appropriateness of prescribing in elderly patients, and to explore the relationship between these results and hospital care utilization during a 12-month follow-up period.The study population from a previous randomized controlled study, in which the effects of a comprehensive pharmacist intervention on re-hospitalization was investigated, was used. The criteria from the instruments MAI, STOPP and START were applied retrospectively to the 368 study patients (intervention group (I n = 182, control group (C n = 186. The assessments were done on admission and at discharge to detect differences over time and between the groups. Hospital care consumption was recorded and the association between scores for appropriateness, and hospitalization was analysed.The number of Potentially Inappropriate Medicines (PIMs per patient as identified by STOPP was reduced for I but not for C (1.42 to 0.93 vs. 1.46 to 1.66 respectively, p<0.01. The number of Potential Prescription Omissions (PPOs per patient as identified by START was reduced for I but not for C (0.36 to 0.09 vs. 0.42 to 0.45 respectively, p<0.001. The summated score for MAI was reduced for I but not for C (8.5 to 5.0 and 8.7 to 10.0 respectively, p<0.001. There was a positive association between scores for MAI and STOPP and drug-related readmissions (RR 8-9% and 30-34% respectively. No association was detected between the scores of the tools and total re-visits to hospital.The interventions significantly improved the appropriateness of prescribing for patients in the intervention group as evaluated by the instruments MAI, STOPP and START. High scores in MAI and STOPP were associated with a higher number of drug-related readmissions.

  5. A QUASI EXPERIMENTAL STUDY TO EVALUATE EFFECTIVENESS OF GLYCERIN MAGNESIUM SULPHATE DRESSING ON PHLEBITIS AMONG PATIENTS UNDERGOING PERIPHERAL INTRAVENOUS INFUSION IN SELECTED HOSPITAL,VADODARA

    Directory of Open Access Journals (Sweden)

    Ravindra HN, Patel Krupa D

    2015-07-01

    Full Text Available Introduction: Intravenous therapy is indicated for many reasons. A significant number of patients admitted into hospital receive some forms of intravenous therapy through peripheral venous cannula, which is a common procedure carried out in hospital to allow rapid and accurate administration of medication. However, the intravenous cannulation can have undesirable effects, the most of which is phlebitis, which is due to mechanical, chemical or infectious cause. Method: In this study quasi-experimental research approach was used. Non probability purposive sampling technique was used to select the sample from the selected hospital. The research design adopted for the study was pre-test, post-test control group design. In the present study a sample of 60 hospitalised patients and who met the inclusion criteria was selected from the target population. In this study the instruments used are baseline Performa, structured interview schedule to assess the subjective symptoms and observation scale to observe the objective symptoms. Result: In experimental group post test mean score 1.10, SD was 0.71 respectively. In control group post test mean score 2.53, SD was 0.78 respectively. The obtained value 7.454 statistically was significant at 0.001 levels. So research hypothesis was accepted. So there was significant difference between post intervention phlebitis among the experimental group and control group. Discussion: In the research study findings revealed that Glycerin Magnesium sulphate dressing is highly effective in decrease phlebitis level to the patients.

  6. Randomized, controlled, multicentre clinical trial of the antipyretic effect of intravenous paracetamol in patients admitted to hospital with infection.

    Science.gov (United States)

    Tsaganos, Thomas; Tseti, Ioulia K; Tziolos, Nikolaos; Soumelas, Georgios-Stefanos; Koupetori, Marina; Pyrpasopoulou, Athina; Akinosoglou, Karolina; Gogos, Charalambos; Tsokos, Nikolaos; Karagiannis, Asterios; Sympardi, Styliani; Giamarellos-Bourboulis, Evangelos J

    2017-04-01

    No randomized study has been conducted to investigate the use of intravenous paracetamol (acetaminophen, APAP) for the management of fever due to infection. The present study evaluated a new ready-made infusion of paracetamol. Eighty patients with a body temperature onset ≥38.5°C in the previous 24 h due to infection were randomized to a single administration of placebo (n = 39) or 1 g paracetamol (n = 41), and their temperature was recorded at standard intervals. Rescue medication with 1 g paracetamol was allowed. Serum samples were collected for the measurement of APAP and its metabolites. The primary endpoint was defervescence, defined as a core temperature ≤37.1°C. During the first 6 h, defervescence was achieved in 15 (38.5%) patients treated with placebo compared with 33 (80.5%) patients treated with paracetamol 1 g (P paracetamol 1 g was 3 h. Rescue medication was given to 15 (38.5%) and five (12.2%) patients allocated to placebo and paracetamol, respectively (P = 0.007); nine (60.0%) and two (40.0%) of these patients, respectively, experienced defervescence. No further antipyretic medication was needed for patients becoming afebrile with rescue medication. Serum glucuronide-APAP concentrations were significantly greater in the serum of patients who did not experience defervescence with paracetamol. The efficacy of paracetamol was not affected by serum creatinine. No drug-related adverse events were reported. The 1 g paracetamol formulation has a rapid and sustainable antipyretic effect on fever due to infection. Its efficacy is dependent on hepatic metabolism. © 2016 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

  7. Optimal Subset Selection of Time-Series MODIS Images and Sample Data Transfer with Random Forests for Supervised Classification Modelling

    Directory of Open Access Journals (Sweden)

    Fuqun Zhou

    2016-10-01

    Full Text Available Nowadays, various time-series Earth Observation data with multiple bands are freely available, such as Moderate Resolution Imaging Spectroradiometer (MODIS datasets including 8-day composites from NASA, and 10-day composites from the Canada Centre for Remote Sensing (CCRS. It is challenging to efficiently use these time-series MODIS datasets for long-term environmental monitoring due to their vast volume and information redundancy. This challenge will be greater when Sentinel 2–3 data become available. Another challenge that researchers face is the lack of in-situ data for supervised modelling, especially for time-series data analysis. In this study, we attempt to tackle the two important issues with a case study of land cover mapping using CCRS 10-day MODIS composites with the help of Random Forests’ features: variable importance, outlier identification. The variable importance feature is used to analyze and select optimal subsets of time-series MODIS imagery for efficient land cover mapping, and the outlier identification feature is utilized for transferring sample data available from one year to an adjacent year for supervised classification modelling. The results of the case study of agricultural land cover classification at a regional scale show that using only about a half of the variables we can achieve land cover classification accuracy close to that generated using the full dataset. The proposed simple but effective solution of sample transferring could make supervised modelling possible for applications lacking sample data.

  8. Biased random key genetic algorithm with insertion and gender selection for capacitated vehicle routing problem with time windows

    Science.gov (United States)

    Rochman, Auliya Noor; Prasetyo, Hari; Nugroho, Munajat Tri

    2017-06-01

    Vehicle Routing Problem (VRP) often occurs when the manufacturers need to distribute their product to some customers/outlets. The distribution process is typically restricted by the capacity of the vehicle and the working hours at the distributor. This type of VRP is also known as Capacitated Vehicle Routing Problem with Time Windows (CVRPTW). A Biased Random Key Genetic Algorithm (BRKGA) was designed and coded in MATLAB to solve the CVRPTW case of soft drink distribution. The standard BRKGA was then modified by applying chromosome insertion into the initial population and defining chromosome gender for parent undergoing crossover operation. The performance of the established algorithms was then compared to a heuristic procedure for solving a soft drink distribution. Some findings are revealed (1) the total distribution cost of BRKGA with insertion (BRKGA-I) results in a cost saving of 39% compared to the total cost of heuristic method, (2) BRKGA with the gender selection (BRKGA-GS) could further improve the performance of the heuristic method. However, the BRKGA-GS tends to yield worse results compared to that obtained from the standard BRKGA.

  9. Sequence-Based Prediction of RNA-Binding Proteins Using Random Forest with Minimum Redundancy Maximum Relevance Feature Selection

    Directory of Open Access Journals (Sweden)

    Xin Ma

    2015-01-01

    Full Text Available The prediction of RNA-binding proteins is one of the most challenging problems in computation biology. Although some studies have investigated this problem, the accuracy of prediction is still not sufficient. In this study, a highly accurate method was developed to predict RNA-binding proteins from amino acid sequences using random forests with the minimum redundancy maximum relevance (mRMR method, followed by incremental feature selection (IFS. We incorporated features of conjoint triad features and three novel features: binding propensity (BP, nonbinding propensity (NBP, and evolutionary information combined with physicochemical properties (EIPP. The results showed that these novel features have important roles in improving the performance of the predictor. Using the mRMR-IFS method, our predictor achieved the best performance (86.62% accuracy and 0.737 Matthews correlation coefficient. High prediction accuracy and successful prediction performance suggested that our method can be a useful approach to identify RNA-binding proteins from sequence information.

  10. A preliminary investigation of the jack-bean urease inhibition by randomly selected traditionally used herbal medicine.

    Science.gov (United States)

    Biglar, Mahmood; Soltani, Khadijeh; Nabati, Farzaneh; Bazl, Roya; Mojab, Faraz; Amanlou, Massoud

    2012-01-01

    Helicobacter pylori (H. pylori) infection leads to different clinical and pathological outcomes in humans, including chronic gastritis, peptic ulcer disease and gastric neoplasia and even gastric cancer and its eradiation dependst upon multi-drug therapy. The most effective therapy is still unknown and prompts people to make great efforts to find better and more modern natural or synthetic anti-H. pylori agents. In this report 21 randomly selected herbal methanolic extracts were evaluated for their effect on inhibition of Jack-bean urease using the indophenol method as described by Weatherburn. The inhibition potency was measured by UV spectroscopy technique at 630 nm which attributes to released ammonium. Among these extracts, five showed potent inhibitory activities with IC50 ranges of 18-35 μg/mL. These plants are Matricaria disciforme (IC50:35 μg/mL), Nasturtium officinale (IC50:18 μg/mL), Punica granatum (IC50:30 μg/mL), Camelia sinensis (IC50:35 μg/mL), Citrus aurantifolia (IC50:28 μg/mL).

  11. A brief, web-based personalized feedback selective intervention for college student marijuana use: a randomized clinical trial.

    Science.gov (United States)

    Lee, Christine M; Neighbors, Clayton; Kilmer, Jason R; Larimer, Mary E

    2010-06-01

    Despite clear need, brief web-based interventions for marijuana-using college students have not been evaluated in the literature. The current study was designed to evaluate a brief, web-based personalized feedback intervention for at-risk marijuana users transitioning to college. All entering first-year students were invited to complete a brief questionnaire. Participants meeting criteria completed a baseline assessment (N = 341) and were randomly assigned to web-based personalized feedback or assessment-only control conditions. Participants completed 3-month (95.0%) and 6-month (94.4%) follow-up assessments. Results indicated that although there was no overall intervention effect, moderator analyses found promising effects for those with a family history of drug problems and, to a smaller extent, students who were higher in contemplation of changing marijuana use at baseline. Implications of these findings for selective intervention of college marijuana use and web-based interventions in general are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  12. Optimal Subset Selection of Time-Series MODIS Images and Sample Data Transfer with Random Forests for Supervised Classification Modelling.

    Science.gov (United States)

    Zhou, Fuqun; Zhang, Aining

    2016-10-25

    Nowadays, various time-series Earth Observation data with multiple bands are freely available, such as Moderate Resolution Imaging Spectroradiometer (MODIS) datasets including 8-day composites from NASA, and 10-day composites from the Canada Centre for Remote Sensing (CCRS). It is challenging to efficiently use these time-series MODIS datasets for long-term environmental monitoring due to their vast volume and information redundancy. This challenge will be greater when Sentinel 2-3 data become available. Another challenge that researchers face is the lack of in-situ data for supervised modelling, especially for time-series data analysis. In this study, we attempt to tackle the two important issues with a case study of land cover mapping using CCRS 10-day MODIS composites with the help of Random Forests' features: variable importance, outlier identification. The variable importance feature is used to analyze and select optimal subsets of time-series MODIS imagery for efficient land cover mapping, and the outlier identification feature is utilized for transferring sample data available from one year to an adjacent year for supervised classification modelling. The results of the case study of agricultural land cover classification at a regional scale show that using only about a half of the variables we can achieve land cover classification accuracy close to that generated using the full dataset. The proposed simple but effective solution of sample transferring could make supervised modelling possible for applications lacking sample data.

  13. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial.

    Science.gov (United States)

    Liao, Lin-Yu; Chen, Kuei-Min; Chung, Wei-Sheng; Chien, Jung-Yien

    2015-01-01

    NCT02329873. Acute exacerbation (AE) of COPD is characterized by a sudden worsening of COPD symptoms. Previous studies have explored the effectiveness of respiratory rehabilitation for patients with COPD; however, no training program specific to acute exacerbation in elderly patients or unstable periods during hospitalization has been developed. To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD. A randomized control trial was conducted. Pretest and posttest evaluations of 61 elderly inpatients with AECOPD (experimental group n=30; control group n=31) were performed. The experimental group received respiratory rehabilitation exercise training twice a day, 10-30 minutes per session for 4 days. The clinical parameters (dyspnea, cough, exercise tolerance, and sputum expectoration) were assessed at the baseline and at the end of the fourth day. All participants (median age =70 years, male =60.70%, and peak expiratory flow 140 L) completed the study. In the patients of the experimental group, dyspnea and cough decreased and exercise tolerance and sputum expectoration increased significantly compared with those of the patients in the control group (all Prespiratory rehabilitation exercise training package reduced symptoms and enhanced the effectiveness of the care of elderly inpatients with AECOPD.

  14. Effects of Peer Mentoring on Self-Efficacy and Hospital Readmission After Inpatient Rehabilitation of Individuals With Spinal Cord Injury: A Randomized Controlled Trial.

    Science.gov (United States)

    Gassaway, Julie; Jones, Michael L; Sweatman, W Mark; Hong, Minna; Anziano, Peter; DeVault, Karen

    2017-08-01

    To investigate the effect of intensive peer mentoring on patient-reported outcomes of self-efficacy and unplanned hospital readmissions for persons with spinal cord injury/disease (SCI/D) within the first 6 months after discharge from inpatient rehabilitation. Randomized controlled trial. Nonprofit inpatient rehabilitation hospital specializing in care of persons with SCI/D and brain injury. Patients (N=158) admitted to the SCI/D rehabilitation program whose discharge location was a community setting. Participants (51% with paraplegia and 49% with tetraplegia) were 73% white and 77% men, with a mean age of 38 years. Participants in the experimental group received initial consult/introduction with a peer support program liaison and were assigned a peer mentor, who met with the participant weekly throughout the inpatient stay and made weekly contact by phone, e-mail, or in person for 90 days postdischarge. Participants also were encouraged to participate in regularly scheduled peer support activities. Nonexperimental group participants were introduced to peer support and provided services only on request. General Self-efficacy Scale (adapted to SCI/D), project-developed community integration self-efficacy scale, and patient-reported unplanned rehospitalizations. Growth rate for self-efficacy in the first 6 months postdischarge was significantly higher for experimental group participants than nonexperimental group participants. Experimental group participants also had significantly fewer unplanned hospital days. This study provides evidence that individuals receiving intensive peer mentoring during and after rehabilitation for SCI/D demonstrate greater gains in self-efficacy over time and have fewer days of unplanned rehospitalization in the first 180 days postdischarge. More research is needed to examine the long-term effects of this intervention on health care utilization and the relation between improved health and patient-reported quality of life outcomes

  15. The effects of inpatient exercise therapy on the length of hospital stay in stages I-III colon cancer patients: randomized controlled trial.

    Science.gov (United States)

    Ahn, Ki-Yong; Hur, Hyuk; Kim, Dong-Hyun; Min, Jihee; Jeong, Duck Hyoun; Chu, Sang Hui; Lee, Ji Won; Ligibel, Jennifer A; Meyerhardt, Jeffrey A; Jones, Lee W; Jeon, Justin Y; Kim, Nam Kyu

    2013-05-01

    This study aimed to examine the effects of a postsurgical, inpatient exercise program on postoperative recovery in operable colon cancer patients We conducted the randomized controlled trial with two arms: postoperative exercise vs. usual care. Patients with stages I-III colon cancer who underwent colectomy between January and December 2011 from the Colorectal Cancer Clinic, were recruited for the study. Subjects in the intervention group participated in the postoperative inpatient exercise program consisted of twice daily exercise, including stretching, core, balance, and low-intensity resistance exercises. The usual care group was not prescribed a structured exercise program. The primary endpoint was the length of hospital stay. Secondary endpoints were time to flatus, time to first liquid diet, anthropometric measurements, and physical function measurements. A total of 31 (86.1 %) patients completed the trial, with adherence to exercise interventions at 84.5 %. The mean length of hospital stay was 7.82 ± 1.07 days in the exercise group compared with 9.86 ± 2.66 days in usual care (mean difference, 2.03 days; 95 % confidence interval (CI), -3.47 to -0.60 days; p = 0.005) in per-protocol analysis. The mean time to flatus was 52.18 ± 21.55 h in the exercise group compared with 71.86 ± 29.2 h in the usual care group (mean difference, 19.69 h; 95 % CI, -38.33 to -1.04 h; p = 0.036). Low-to-moderate-intensity postsurgical exercise reduces length of hospital stay and improves bowel motility after colectomy procedure in patients with stages I-III colon cancer.

  16. Can early introduction of specialized palliative care limit intensive care, emergency and hospital admissions in patients with severe and very severe COPD? a randomized study.

    Science.gov (United States)

    Weber, Catherine; Stirnemann, Jerome; Herrmann, François R; Pautex, Sophie; Janssens, Jean-Paul

    2014-10-21

    COPD is a progressive lung disorder with rates of mortality between 36-50%, within 2 years after admission for an acute exacerbation. While treatment with inhaled bronchodilators and steroids may partially relieve symptoms and oxygen therapy may prolong life, for many patients the course of the disease is one of inexorable decline. Very few palliative care intervention studies are available for this population. This trial seeks to determine the effectiveness of the introduction of specialized palliative care on hospital, intensive care unit and emergency admissions of patients with severe and very severe COPD. The study is a three year single centre, randomized controlled trial using a 2 arms parallel groups design conducted in a tertiary center (University Hospitals; Geneva). For the intervention group, an early palliative care consultation is added to standard care; the control group benefits from standard care only. Patients with COPD defined according to GOLD criteria with a stage III or IV disease and/or long term treatment with domiciliary oxygen and/or home mechanical ventilation and/or one or more hospital admissions in the previous year for an acute exacerbation are eligible to participate. Allocation concealment is achieved using randomisation by sealed envelopes. Our sample size of 90 patients/group gives the study a 80% power to detect a 20% decrease in intensive care unit and emergency admissions--the primary endpoint. All data regarding participants will be analysed by a researcher blinded to treatment allocation, according to the "Intention to treat" principle. Given the trends toward aggressive and costly care near end-of-life among patients with COPD, a timely introduction of palliative care may limit unnecessary and burdensome personal and societal costs, and invasive approaches. The results of this study may provide directions for future palliative care interventions in this particular population. This trial has been registered at clinicaltrials

  17. Hospital Outpatient PPS Partial Hospitalization Program LDS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Partial Hospitalization Program LDS This file contains select claim level data and is derived from 2010 claims...

  18. Evaluation Of Triple And Quadruple Regimens In Eradication Of Helicobacter Pylori Infection In Pediatric Patients In Emam Khomeini Hospital In 2002-2003: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Heshmat Moayeri

    2005-05-01

    Full Text Available Background: Triple therapy with a proton pump inhibitor, clarithromycin and amoxicillin and quadruple therapy with a proton pump inhibitor, bismuth citrate, metronidazole and amoxicillin have been proposed in Maastricht 2000 as the optimal treatment of Helicobacter pylori infection. We aimed to compare these two regimens in Iranian pediatric patients. Methods: A randomized clinical trial in Em am Khomeini Hospital between 13 81 and 1382 was done. Patients with confirmed H. pylori infection by histology were divided in to two groups in a randomized 1: 1 scheme. Triple regimen group: Clarithromycin 15 mg/kg/d, Amoxicillin 50 mglkg/d and Omeprazole 1 mg/kg/day for 10 days. Quadruple regimen group: Omeprazole 1 mg/kg/d, Amoxicillin 50 mglkg/day, Metronidazole 20 mglkg/day and Bismuth citrate 8 mglkg for 10 days. The eradication was assessed by c-urea breath test 4 weeks after the end of treatment and byperprotocol analysis. Results: In our study, 100 patients (50 in each group were found and the eradication rates in the triple and quadruple group were 92% and 84% respectively (p=0.046. Conclusion: According to our results, we recommend triple therapy as first-line treatment in Iranian pediatric patients and quadruple therapy as a second line regimen.

  19. Low-FODMAP formula improves diarrhea and nutritional status in hospitalized patients receiving enteral nutrition: a randomized, multicenter, double-blind clinical trial.

    Science.gov (United States)

    Yoon, So Ra; Lee, Jong Hwa; Lee, Jae Hyang; Na, Ga Yoon; Lee, Kyun-Hee; Lee, Yoon-Bok; Jung, Gu-Hun; Kim, Oh Yoen

    2015-11-03

    Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are poorly absorbed, short-chain carbohydrates that play an important role in inducing functional gut symptoms. A low-FODMAP diet improves abdominal symptoms in patients with inflammatory bowel disease and irritable bowel syndrome. However, there were no study for the effect of FODMAP content on gastrointestinal intolerance and nutritional status in patients receiving enteral nutrition (EN). In this randomized, multicenter, double-blind, 14-day clinical trial, eligible hospitalized patients receiving EN (n = 100) were randomly assigned to three groups; 84 patients completed the trial (low-FODMAP EN, n = 30; moderate-FODMAP EN, n = 28; high-FODMAP EN, n = 26). Anthropometric and biochemical parameters were measured; stool assessment was performed using the King's Stool Chart and clinical definition. Baseline values were not significantly different among the three groups. After the 14-day intervention, diarrhea significantly improved in the low-FODMAP group than in the moderate- and high-FODMAP groups (P nutritional status and facilitating prompt recovery from illness.

  20. Mild therapeutic hypothermia in patients resuscitated from out-of-hospital cardiac arrest: A meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Pedro A Villablanca

    2016-01-01

    Full Text Available Aims: Guidelines recommend mild therapeutic hypothermia (MTH for survivors of out-of-hospital cardiac arrest (OHCA. However, there is little literature demonstrating a survival benefit. We performed a meta-analysis of randomized controlled trials (RCTs assessing the efficacy of MTH in patients successfully resuscitated from OHCA. Materials and Methods: Electronic databases were searched for RCT involving MTH in survivors of OHCA, and the results were put through a meta-analysis. The primary endpoint was all-cause mortality, and the secondary endpoint was favorable neurological function. Odds ratios (ORs and 95% confidence intervals (CIs were computed using the Mantel-Haenszel method. A fixed-effect model was used and, if heterogeneity (I2 was >40, effects were analyzed using a random model. Results: Six RCT (n = 1400 patients were included. Overall survival was 50.7%, and favorable neurological recovery was 45.5%. Pooled data demonstrated no significant all-cause mortality (OR, 0.81; 95% CI 0.55-1.21 or neurological recovery (OR, 0.77; 95% CI 0.47-1.24. No evidence of publication bias was observed. Conclusion: This meta-analysis demonstrated that MTH did not confer benefit on overall survival rate and neurological recovery in patients resuscitated from OHCA.

  1. Mild therapeutic hypothermia in patients resuscitated from out-of-hospital cardiac arrest: A meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Villablanca, Pedro A; Makkiya, Mohammed; Einsenberg, Evann; Briceno, David F; Panagiota, Christia; Menegus, Mark; Garcia, Mario; Sims, Daniel; Ramakrishna, Harish

    2016-01-01

    Guidelines recommend mild therapeutic hypothermia (MTH) for survivors of out-of-hospital cardiac arrest (OHCA). However, there is little literature demonstrating a survival benefit. We performed a meta-analysis of randomized controlled trials (RCTs) assessing the efficacy of MTH in patients successfully resuscitated from OHCA. Electronic databases were searched for RCT involving MTH in survivors of OHCA, and the results were put through a meta-analysis. The primary endpoint was all-cause mortality, and the secondary endpoint was favorable neurological function. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using the Mantel-Haenszel method. A fixed-effect model was used and, if heterogeneity (I2 ) was >40, effects were analyzed using a random model. Six RCT (n = 1400 patients) were included. Overall survival was 50.7%, and favorable neurological recovery was 45.5%. Pooled data demonstrated no significant all-cause mortality (OR, 0.81; 95% CI 0.55-1.21) or neurological recovery (OR, 0.77; 95% CI 0.47-1.24). No evidence of publication bias was observed. This meta-analysis demonstrated that MTH did not confer benefit on overall survival rate and neurological recovery in patients resuscitated from OHCA.

  2. Home-based versus hospital-based high-intensity interval training in cardiac rehabilitation: a randomized study.

    Science.gov (United States)

    Aamot, Inger-Lise; Forbord, Siv Hege; Gustad, Kjersti; Løckra, Vibeke; Stensen, Andreas; Berg, Astrid Tarlebø; Dalen, Håvard; Karlsen, Trine; Støylen, Asbjørn

    2014-09-01

    High-intensity interval training (HIT) as exercise therapy is gradually implemented in cardiac rehabilitation as the cardiovascular benefits from exercise is intensity dependent. However, in previous studies, HIT has been performed with strict supervision. The aim of the study was to assess the feasibility and effectiveness of different modes of HIT in cardiac rehabilitation. a randomized clinical study. Ninety participants with coronary artery disease (80 men/10 women, mean age 57 ± 8 years) were randomly assigned to one of three exercise modes: group exercise (GE), treadmill exercise (TE), or home-based exercise (HE). HIT was performed twice a week for 12 weeks with an exercise intensity of 85-95% of peak heart rate. The primary outcome measure was change in peak oxygen uptake (peak VO2). Eighty-three participants (92%) completed the intervention without any severe adverse events. Peak VO2 increased from 34.7 ± 7.3 to 39.0 ± 8.0 ml/kg/min, 32.7 ± 6.5 to 36.0 ± 6.2 ml/kg/min, and 34.4 ± 4.8 to 37.2 ± 5.2 ml/kg/min in TE, GE, and HE, respectively. Mean group difference for TE vs. HE was 1.6 ml/kg/min (95% confidence interval, CI, 0.7 to 3.1, p = 0.02), TE vs. GE 1.1 ml/kg/min (95% CI-0.5 to 2.5, p = 0.27), and GE vs. HE 0.6 ml/kg/min (95% CI -1.0 to 2.1, p = 1). However, on-treatment analysis showed no significant difference between groups. HIT was efficiently performed in three settings of cardiac rehabilitation, with respect to target exercise intensity, exercise attendance, and increase in peak VO2. Exercise mode was not essential for exercise capacity. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  3. A Pragmatic Randomized Controlled Trial of 6-Step vs 3-Step Hand Hygiene Technique in Acute Hospital Care in the United Kingdom.

    Science.gov (United States)

    Reilly, Jacqui S; Price, Lesley; Lang, Sue; Robertson, Chris; Cheater, Francine; Skinner, Kirsty; Chow, Angela

    2016-06-01

    OBJECTIVE To evaluate the microbiologic effectiveness of the World Health Organization's 6-step and the Centers for Disease Control and Prevention's 3-step hand hygiene techniques using alcohol-based handrub. DESIGN A parallel group randomized controlled trial. SETTING An acute care inner-city teaching hospital (Glasgow). PARTICIPANTS Doctors (n=42) and nurses (n=78) undertaking direct patient care. INTERVENTION Random 1:1 allocation of the 6-step (n=60) or the 3-step (n=60) technique. RESULTS The 6-step technique was microbiologically more effective at reducing the median log10 bacterial count. The 6-step technique reduced the count from 3.28 CFU/mL (95% CI, 3.11-3.38 CFU/mL) to 2.58 CFU/mL (2.08-2.93 CFU/mL), whereas the 3-step reduced it from 3.08 CFU/mL (2.977-3.27 CFU/mL) to 2.88 CFU/mL (-2.58 to 3.15 CFU/mL) (P=.02). However, the 6-step technique did not increase the total hand coverage area (98.8% vs 99.0%, P=.15) and required 15% (95% CI, 6%-24%) more time (42.50 seconds vs 35.0 seconds, P=.002). Total hand coverage was not related to the reduction in bacterial count. CONCLUSIONS Two techniques for hand hygiene using alcohol-based handrub are promoted in international guidance, the 6-step by the World Health Organization and 3-step by the Centers for Disease Control and Prevention. The study provides the first evidence in a randomized controlled trial that the 6-step technique is superior, thus these international guidance documents should consider this evidence, as should healthcare organizations using the 3-step technique in practice. Infect Control Hosp Epidemiol 2016;37:661-666.

  4. Effectiveness of cognitive behavior therapy in tobacco cessation at a dental setting: A hospital-based randomized controlled trial

    Directory of Open Access Journals (Sweden)

    A Leena Selvamary

    2016-01-01

    Full Text Available Introduction: Tobacco use continues to be the leading global cause of preventable death. Dental health professionals play a significant role in the intervention of the tobacco-related epidemic. Aim: The aim of this study was to compare the effectiveness of health education (HE alone and HE with cognitive behavior therapy (CBT at a dental tertiary referral unit of South India. Materials and Methods: Self-reported quit attempt was assessed and the sample size was estimated at 194. Tobacco users who met the inclusion criteria were randomly assigned to one of the two groups - HE only and HE with CBT. Age, sex, socioeconomic status, form of tobacco usage, alcohol usage, addiction and stage of motivation, knowledge, attitude, and behavior regarding tobacco use, and ill effects were assessed at baseline. Follow-up was for 6 months (2nd, 6th, 12th, and 24th weeks to assess reduced use, quit attempt, point prevalence abstinence, continuous abstinence, lapse, relapse, and attrition rates in each visit. The self-reported quit rates were validated using the standardized cotinine test. Pearson's Chi-square test was used to determine the effectiveness of intervention. Results: Continuous abstinence was significantly high in CBT. Reduced use and point prevalence abstinence were significantly higher in HE. Quit attempt in both the groups was equal showing no statistical significance. Attrition was significantly higher in HE compared to CBT. Conclusion: CBT plays a vital role in achieving continuous abstinence, overcoming social factors, and reducing lapse among the tobacco users.

  5. Effects of a wearable type lumbosacral support for low back pain among hospital workers: A randomized controlled trial.

    Science.gov (United States)

    Hagiwara, Yoshihiro; Yabe, Yutaka; Yamada, Hiroyuki; Watanabe, Takashi; Kanazawa, Kenji; Koide, Masashi; Sekiguchi, Takuya; Hatano, Hirokazu; Itoi, Eiji

    2017-03-28

    To examine the effects of a new wearable type of lumbosacral support on low back pain. A total of 121 healthcare workers participated in this study. They were randomly allocated into the experimental and control groups and the former wore the support with signals of compression on the back by poor posture for the first 3 months. The control group remained on a waiting list for the first 3 months. Medical history, musculoskeletal symptoms, feeling in good posture, sleep habits, psychological distress, Roland-Morris Disability Questionnaire, and Somatosensory Amplification Scale (SSAS) were evaluated. The range of motion (ROM) in the shoulder and hip joints as well as spinal alignment were evaluated. Our primary concern was the difference in the change of low back pain measured by visual analog scale (VAS) between the two groups. A total of 54 participants in the experimental and 53 participants in the control groups were analyzed. VAS and SSAS scores as well as lumbar spinal ROM in the experimental group significantly decreased. Low back pain (OR=0.401, 95% CI=0.168-0.954) and neck pain in the experimental group (OR=0.198, 95% CI=0.052-0.748) significantly decreased. The new lumbar support reduced VAS and SSAS scores, lumbar spinal ROM, low back pain, and neck pain. This new type of lumbar support reduced low back pain among healthcare workers.

  6. Effects of a wearable type lumbosacral support for low back pain among hospital workers: A randomized controlled trial

    Science.gov (United States)

    Hagiwara, Yoshihiro; Yabe, Yutaka; Yamada, Hiroyuki; Watanabe, Takashi; Kanazawa, Kenji; Koide, Masashi; Sekiguchi, Takuya; Hatano, Hirokazu; Itoi, Eiji

    2017-01-01

    Objective: To examine the effects of a new wearable type of lumbosacral support on low back pain. Methods: A total of 121 healthcare workers participated in this study. They were randomly allocated into the experimental and control groups and the former wore the support with signals of compression on the back by poor posture for the first 3 months. The control group remained on a waiting list for the first 3 months. Medical history, musculoskeletal symptoms, feeling in good posture, sleep habits, psychological distress, Roland-Morris Disability Questionnaire, and Somatosensory Amplification Scale (SSAS) were evaluated. The range of motion (ROM) in the shoulder and hip joints as well as spinal alignment were evaluated. Our primary concern was the difference in the change of low back pain measured by visual analog scale (VAS) between the two groups. Results: A total of 54 participants in the experimental and 53 participants in the control groups were analyzed. VAS and SSAS scores as well as lumbar spinal ROM in the experimental group significantly decreased. Low back pain (OR=0.401, 95% CI=0.168-0.954) and neck pain in the experimental group (OR=0.198, 95% CI=0.052-0.748) significantly decreased. Conclusions: The new lumbar support reduced VAS and SSAS scores, lumbar spinal ROM, low back pain, and neck pain. This new type of lumbar support reduced low back pain among healthcare workers. PMID:28132971

  7. Enumeration of Escherichia coli cells on chicken carcasses as a potential measure of microbial process control in a random selection of slaughter establishments in the United States

    Science.gov (United States)

    The purpose of this study was to evaluate whether the measurement of Escherichia coli levels at two points during the chicken slaughter process has utility as a measure of quality control. A one year long survey was conducted during 2004 and 2005 in 20 randomly selected United States chicken slaught...

  8. Impact of amoxicillin therapy on resistance selection in patients with community-acquired lower respiratory tract infections : A randomized, placebo-controlled study

    NARCIS (Netherlands)

    Malhotra-Kumar, Surbhi; Van Heirstraeten, Liesbet; Coenen, Samuel; Lammens, Christine; Adriaenssens, Niels; Kowalczyk, Anna; Godycki-Cwirko, Maciek; Bielicka, Zuzana; Hupkova, Helena; Lannering, Christina; Mölstad, Sigvard; Fernandez-Vandellos, Patricia; Torres, Antoni; Parizel, Maxim; Ieven, Margareta; Butler, Chris C.; Verheij, Theo; Little, Paul; Goossens, Hermanon; Frimodt-Møller, Niels; Bruno, Pascale; Hering, Iris; Lemiengre, Marieke; Loens, Katherine; Malmvall, Bo Eric; Muras, Magdalena; Romano, Nuria Sanchez; Prat, Matteu Serra; Svab, Igor; Swain, Jackie; Tarsia, Paolo; Leus, Frank; Veen, Robert; Worby, Tricia

    2016-01-01

    Objectives: To determine the effect of amoxicillin treatment on resistance selection in patients with community-acquired lower respiratory tract infections in a randomized, placebo-controlled trial. Methods: Patients were prescribed amoxicillin 1 g, three times daily (n = 52) or placebo (n = 50) for

  9. The Long-Term Effectiveness of a Selective, Personality-Targeted Prevention Program in Reducing Alcohol Use and Related Harms: A Cluster Randomized Controlled Trial

    Science.gov (United States)

    Newton, Nicola C.; Conrod, Patricia J.; Slade, Tim; Carragher, Natacha; Champion, Katrina E.; Barrett, Emma L.; Kelly, Erin V.; Nair, Natasha K.; Stapinski, Lexine; Teesson, Maree

    2016-01-01

    Background: This study investigated the long-term effectiveness of Preventure, a selective personality-targeted prevention program, in reducing the uptake of alcohol, harmful use of alcohol, and alcohol-related harms over a 3-year period. Methods: A cluster randomized controlled trial was conducted to assess the effectiveness of Preventure.…

  10. Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management.

    Science.gov (United States)

    Nelson, Lewis S; Erdman, Andrew R; Booze, Lisa L; Cobaugh, Daniel J; Chyka, Peter A; Woolf, Alan D; Scharman, Elizabeth J; Wax, Paul M; Manoguerra, Anthony S; Christianson, Gwenn; Caravati, E Martin; Troutman, William G

    2007-05-01

    A review of US poison center data for 2004 showed over 48,000 exposures to selective serotonin reuptake inhibitors (SSRIs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with a suspected ingestion of an SSRI by 1) describing the process by which an ingestion of an SSRI might be managed, 2) identifying the key decision elements in managing cases of SSRI ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of immediate-release forms of SSRIs alone. Co-ingestion of additional substances might require different referral and management recommendations depending on their combined toxicities. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) All

  11. Effect of Inhaled Xenon on Cerebral White Matter Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial.

    Science.gov (United States)

    Laitio, Ruut; Hynninen, Marja; Arola, Olli; Virtanen, Sami; Parkkola, Riitta; Saunavaara, Jani; Roine, Risto O; Grönlund, Juha; Ylikoski, Emmi; Wennervirta, Johanna; Bäcklund, Minna; Silvasti, Päivi; Nukarinen, Eija; Tiainen, Marjaana; Saraste, Antti; Pietilä, Mikko; Airaksinen, Juhani; Valanne, Leena; Martola, Juha; Silvennoinen, Heli; Scheinin, Harry; Harjola, Veli-Pekka; Niiranen, Jussi; Korpi, Kirsi; Varpula, Marjut; Inkinen, Outi; Olkkola, Klaus T; Maze, Mervyn; Vahlberg, Tero; Laitio, Timo

    2016-03-15

    Evidence from preclinical models indicates that xenon gas can prevent the development of cerebral damage after acute global hypoxic-ischemic brain injury but, thus far, these putative neuroprotective properties have not been reported in human studies. To determine the effect of inhaled xenon on ischemic white matter damage assessed with magnetic resonance imaging (MRI). A randomized single-blind phase 2 clinical drug trial conducted between August 2009 and March 2015 at 2 multipurpose intensive care units in Finland. One hundred ten comatose patients (aged 24-76 years) who had experienced out-of-hospital cardiac arrest were randomized. Patients were randomly assigned to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours (n = 55 in the xenon group) or hypothermia treatment alone (n = 55 in the control group). The primary end point was cerebral white matter damage as evaluated by fractional anisotropy from diffusion tensor MRI scheduled to be performed between 36 and 52 hours after cardiac arrest. Secondary end points included neurological outcome assessed using the modified Rankin Scale (score 0 [no symptoms] through 6 [death]) and mortality at 6 months. Among the 110 randomized patients (mean age, 61.5 years; 80 men [72.7%]), all completed the study. There were MRI data from 97 patients (88.2%) a median of 53 hours (interquartile range [IQR], 47-64 hours) after cardiac arrest. The mean global fractional anisotropy values were 0.433 (SD, 0.028) in the xenon group and 0.419 (SD, 0.033) in the control group. The age-, sex-, and site-adjusted mean global fractional anisotropy value was 3.8% higher (95% CI, 1.1%-6.4%) in the xenon group (adjusted mean difference, 0.016 [95% CI, 0.005-0.027], P = .006). At 6 months, 75 patients (68.2%) were alive. Secondary end points at 6 months did not reveal statistically significant differences between the groups. In ordinal analysis of the modified Rankin Scale, the median (IQR) value was 1 (1

  12. Pattern of Bacterial Pathogens and Their Susceptibility Isolated from Surgical Site Infections at Selected Referral Hospitals, Addis Ababa, Ethiopia

    Directory of Open Access Journals (Sweden)

    Walelign Dessie

    2016-01-01

    Full Text Available Background. The emergence of multidrug resistant bacterial pathogens in hospitals is becoming a challenge for surgeons to treat hospital acquired infections. Objective. To determine bacterial pathogens and drug susceptibility isolated from surgical site infections at St. Paul Specialized Hospital Millennium Medical College and Yekatit 12 Referral Hospital Medical College, Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted between October 2013 and March 2014 on 107 surgical site infected patients. Wound specimens were collected using sterile cotton swab and processed as per standard operative procedures in appropriate culture media; and susceptibility testing was done using Kirby-Bauer disc diffusion technique. The data were analyzed by using SPSS version 20. Result. From a total of 107 swabs collected, 90 (84.1% were culture positive and 104 organisms were isolated. E. coli (24 (23.1% was the most common organism isolated followed by multidrug resistant Acinetobacter species (23 (22.1%. More than 58 (75% of the Gram negative isolates showed multiple antibiotic resistance (resistance ≥ 5 drugs. Pan-antibiotic resistance was noted among 8 (34.8% Acinetobacter species and 3 (12.5% E. coli. This calls for abstinence from antibiotic abuse. Conclusion. Gram negative bacteria were the most important isolates accounting for 76 (73.1%. Ampicillin, amoxicillin, penicillin, cephazoline, and tetracycline showed resistance while gentamicin and ciprofloxacin were relatively effective antimicrobials.

  13. Risk of venous thromboembolism in people admitted to hospital with selected immune-mediated diseases: record-linkage study

    Directory of Open Access Journals (Sweden)

    Handel Adam E

    2011-01-01

    Full Text Available Abstract Background Venous thromboembolism (VTE is a common complication during and after a hospital admission. Although it is mainly considered a complication of surgery, it often occurs in people who have not undergone surgery, with recent evidence suggesting that immune-mediated diseases may play a role in VTE risk. We, therefore, decided to study the risk of deep vein thrombosis (DVT and pulmonary embolism (PE in people admitted to hospital with a range of immune-mediated diseases. Methods We analysed databases of linked statistical records of hospital admissions and death certificates for the Oxford Record Linkage Study area (ORLS1:1968 to 1998 and ORLS2:1999 to 2008 and the whole of England (1999 to 2008. Rate ratios for VTE were determined, comparing immune-mediated disease cohorts with comparison cohorts. Results Significantly elevated risks of VTE were found, in all three populations studied, in people with a hospital record of admission for autoimmune haemolytic anaemia, chronic active hepatitis, dermatomyositis/polymyositis, type 1 diabetes mellitus, multiple sclerosis, myasthenia gravis, myxoedema, pemphigus/pemphigoid, polyarteritis nodosa, psoriasis, rheumatoid arthritis, Sjogren's syndrome, and systemic lupus erythematosus. Rate ratios were considerably higher for some of these diseases than others: for example, for systemic lupus erythematosus the rate ratios were 3.61 (2.36 to 5.31 in the ORLS1 population, 4.60 (3.19 to 6.43 in ORLS2 and 3.71 (3.43 to 4.02 in the England dataset. Conclusions People admitted to hospital with immune-mediated diseases may be at an increased risk of subsequent VTE. Our findings need independent confirmation or refutation; but, if confirmed, there may be a role for thromboprophylaxis in some patients with these diseases.

  14. Surveillance for cancer recurrence in long-term young breast cancer survivors randomly selected from a statewide cancer registry.

    Science.gov (United States)

    Jones, Tarsha; Duquette, Debra; Underhill, Meghan; Ming, Chang; Mendelsohn-Victor, Kari E; Anderson, Beth; Milliron, Kara J; Copeland, Glenn; Janz, Nancy K; Northouse, Laurel L; Duffy, Sonia M; Merajver, Sofia D; Katapodi, Maria C

    2018-01-20

    This study examined clinical breast exam (CBE) and mammography surveillance in long-term young breast cancer survivors (YBCS) and identified barriers and facilitators to cancer surveillance practices. Data collected with a self-administered survey from a statewide, randomly selected sample of YBCS diagnosed with invasive breast cancer or ductal carcinoma in situ younger than 45 years old, stratified by race (Black vs. White/Other). Multivariate logistic regression models identified predictors of annual CBEs and mammograms. Among 859 YBCS (n = 340 Black; n = 519 White/Other; mean age = 51.0 ± 5.9; diagnosed 11.0 ± 4.0 years ago), the majority (> 85%) reported an annual CBE and a mammogram. Black YBCS in the study were more likely to report lower rates of annual mammography and more barriers accessing care compared to White/Other YBCS. Having a routine source of care, confidence to use healthcare services, perceived expectations from family members and healthcare providers to engage in cancer surveillance, and motivation to comply with these expectations were significant predictors of having annual CBEs and annual mammograms. Cost-related lack of access to care was a significant barrier to annual mammograms. Routine source of post-treatment care facilitated breast cancer surveillance above national average rates. Persistent disparities regarding access to mammography surveillance were identified for Black YBCS, primarily due to lack of access to routine source of care and high out-of-pocket costs. Public health action targeting cancer surveillance in YBCS should ensure routine source of post-treatment care and address cost-related barriers. Clinical Trials Registration Number: NCT01612338.

  15. Sexual selection has minimal impact on effective population sizes in species with high rates of random offspring mortality: An empirical demonstration using fitness distributions.

    Science.gov (United States)

    Pischedda, Alison; Friberg, Urban; Stewart, Andrew D; Miller, Paige M; Rice, William R

    2015-10-01

    The effective population size (N(e)) is a fundamental parameter in population genetics that influences the rate of loss of genetic diversity. Sexual selection has the potential to reduce N(e) by causing the sex-specific distributions of individuals that successfully reproduce to diverge. To empirically estimate the effect of sexual selection on N(e), we obtained fitness distributions for males and females from an outbred, laboratory-adapted population of Drosophila melanogaster. We observed strong sexual selection in this population (the variance in male reproductive success was ∼14 times higher than that for females), but found that sexual selection had only a modest effect on N(e), which was 75% of the census size. This occurs because the substantial random offspring mortality in this population diminishes the effects of sexual selection on N(e), a result that necessarily applies to other high fecundity species. The inclusion of this random offspring mortality creates a scaling effect that reduces the variance/mean ratios for male and female reproductive success and causes them to converge. Our results demonstrate that measuring reproductive success without considering offspring mortality can underestimate Ne and overestimate the genetic consequences of sexual selection. Similarly, comparing genetic diversity among different genomic components may fail to detect strong sexual selection. © 2015 The Author(s). Evolution © 2015 The Society for the Study of Evolution.

  16. Day Hospital Mentalization-Based Treatment (MBT-DH) versus treatment as usual in the treatment of severe borderline personality disorder: protocol of a randomized controlled trial.

    Science.gov (United States)

    Laurenssen, Elisabeth M P; Westra, Dieuwertje; Kikkert, Martijn J; Noom, Marc J; Eeren, Hester V; van Broekhuyzen, Anna J; Peen, Jaap; Luyten, Patrick; Busschbach, Jan J V; Dekker, Jack J M

    2014-05-22

    Severe borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment (MBT-DH), are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible influence of researcher allegiance in one of the trials, and potential problems with the generalization of findings to mental health systems in other countries, this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands. The trial is being conducted at two sites in The Netherlands. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of ≥ 20 on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual. The MBT-DH program consists of a maximum of 18 months' intensive treatment, followed by a maximum of 18 months of maintenance therapy. Specialist treatment as usual is provided by the City Crisis Service in Amsterdam, a service that specializes in treating patients with personality disorders, offering manualized, non-MBT interventions including family interventions, Linehan training, social skills training, and pharmacotherapy, without a maximum time limit. Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment. The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index. Secondary outcome measures include parasuicidal behaviour, symptomatic distress, social and interpersonal functioning, personality functioning

  17. Effective Recruitment Challenges Faced by the Hospitality Industry in Bangladesh: A Study on Selected Star Rated Residential Hotels

    Directory of Open Access Journals (Sweden)

    Kazi HUDA

    2014-12-01

    Full Text Available In Human Resource Management (HRM, Recruitment is the first and foremost issue to be considered with full of sincerity, because its role is to create a positive impression about the employer in the job market by ensuring effective stimuli for the job seekers. At the beginning, the study sets a picture that focuses on the importance of effective recruitment in the hospitality sector of Bangladesh and then the study details obligatory determinants of attracting efficient human resource for the development of this sector. The main objective of the paper is to study the status and the scopes of recruitment function in hospitality industry with focus towards star rated residential hotels. This study is based on primary data collection through a formal questionnaire. The questionnaire was of mixed mode with most questions in likert-type scale and few were dichotomous in nature. The key finding of the study is that recruitment is a highly challenging task in hospitality and it is quite evident that attractive compensation package is the key factor to attract potential employees. The need and scope to modernize the recruitment practices along with the line of company and employer branding ideas are also recommended in details. There is a long way to go on the way of conceptualizing and actualizing recruitment functions and practices. A paper like this can help to discuss and debate on the necessity of developing better recruitment cultural and conceptual change in these sectors.

  18. Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial.

    Science.gov (United States)

    Machado, Aline Dos Santos; Pires-Neto, Ruy Camargo; Carvalho, Maurício Tatsch Ximenes; Soares, Janice Cristina; Cardoso, Dannuey Machado; Albuquerque, Isabella Martins de

    2017-01-01

    To evaluate the effects that passive cycling exercise, in combination with conventional physical therapy, have on peripheral muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients admitted to the ICU of a tertiary care university hospital. This was a randomized clinical trial involving 38 patients (≥ 18 years of age) on mechanical ventilation who were randomly divided into two groups: control (n = 16), receiving conventional physical therapy; and intervention (n = 22), receiving conventional physical therapy and engaging in passive cycling exercise five days per week. The mean age of the patients was 46.42 ± 16.25 years, and 23 were male. The outcomes studied were peripheral muscle strength, as measured by the Medical Research Council scale, duration of mechanical ventilation, and length of hospital stay. There was a significant increase in peripheral muscle strength (baseline vs. final) in both groups (control: 40.81 ± 7.68 vs. 45.00 ± 6.89; and intervention: 38.73 ± 11.11 vs. 47.18 ± 8.75; p fisioterapia convencional, na força muscular periférica, no tempo de ventilação mecânica e no tempo de internação hospitalar em pacientes críticos internados em UTI de um hospital universitário terciário. Ensaio clínico randomizado envolvendo 38 pacientes (idade > 18 anos) em ventilação mecânica e divididos aleatoriamente em grupo controle (n = 16), que realizou fisioterapia convencional, e grupo intervenção (n = 22) submetidos a fisioterapia convencional e exercícios passivos em cicloergômetro cinco vezes por semana. A média de idade dos pacientes foi de 46,42 ± 16,25 anos, e 23 eram homens. Os desfechos analisados foram força muscular periférica, mensurada pela escala Medical Research Council, tempo de ventilação mecânica e tempo de internação hospitalar. Houve um aumento significativo da força muscular periférica (basal vs. final) tanto no grupo controle (40,81 ± 7,68 vs. 45,00 ± 6

  19. Simulation-based Randomized Comparative Assessment of Out-of-Hospital Cardiac Arrest Resuscitation Bundle Completion by Emergency Medical Service Teams Using Standard Life Support or an Experimental Automation-assisted Approach.

    Science.gov (United States)

    Choi, Bryan; Asselin, Nicholas; Pettit, Catherine C; Dannecker, Max; Machan, Jason T; Merck, Derek L; Merck, Lisa H; Suner, Selim; Williams, Kenneth A; Jay, Gregory D; Kobayashi, Leo

    2016-12-01

    Effective resuscitation of out-of-hospital cardiac arrest (OHCA) patients is challenging. Alternative resuscitative approaches using electromechanical adjuncts may improve provider performance. Investigators applied simulation to study the effect of an experimental automation-assisted, goal-directed OHCA management protocol on EMS providers' resuscitation performance relative to standard protocols and equipment. Two-provider (emergency medical technicians (EMT)-B and EMT-I/C/P) teams were randomized to control or experimental group. Each team engaged in 3 simulations: baseline simulation (standard roles); repeat simulation (standard roles); and abbreviated repeat simulation (reversed roles, i.e., basic life support provider performing ALS tasks). Control teams used standard OHCA protocols and equipment (with high-performance cardiopulmonary resuscitation training intervention); for second and third simulations, experimental teams performed chest compression, defibrillation, airway, pulmonary ventilation, vascular access, medication, and transport tasks with goal-directed protocol and resuscitation-automating devices. Videorecorders and simulator logs collected resuscitation data. Ten control and 10 experimental teams comprised 20 EMT-B's; 1 EMT-I, 8 EMT-C's, and 11 EMT-P's; study groups were not fully matched. Both groups suboptimally performed chest compressions and ventilations at baseline. For their second simulations, control teams performed similarly except for reduced on-scene time, and experimental teams improved their chest compressions (P=0.03), pulmonary ventilations (Pautomation-assisted OHCA management augmented select resuscitation bundle element performance without comprehensive improvement.

  20. Prevalence of Pathogenic Bacteria Isolated from Surgical Site and Wound Infection among Patients Admitted in some selected Hospitals in Sokoto Metropolis, Nigeria

    Directory of Open Access Journals (Sweden)

    UK Muhammad

    2014-09-01

    Full Text Available Surgical and open wounds are commonly encountered in clinical practice. This study was aim to determine the prevalence of pathogenic bacteria in surgical and open wound infection among patients admitted in some selected hospitals in Sokoto metropolis. A total of one hundred and fifty one (151 isolates were obtained from two hundred (200 surgical site and wound samples collected from patients in this study. The result showed that Usmanu Danfodiyo Teaching Hospital Sokoto (UDUTH had the highest number of clinical isolates with 64 gram positive and gram negative bacteria followed by Specialist Hospital Sokoto (S.H.S with 57 gram positive and gram negative bacteria and then Maryam Abacha Women and Children Hospital (MAWCH with 30 gram positive and gram negative bacteria. Gram positive cocci 108 (71.5% were more predominant pathogen isolated in the hospitals than gram negative bacilli 43 (28.5%. Staphylococcus aureus had the highest number of occurrence with 54(35.76% followed by Coagulate negative Staphylococci with 47(31.1% while Citrobacter freundii had the lowest number of occurrence with 2(1.32% isolates. Also, the susceptibility of the isolates to antimicrobial agents were carried out using Amoxacillin, Ampicillin, Erythromycin, Chloramphenicol, Ampiclox, Ciprofloxacin, Gentamycin, Tetracycline, Pefloxacin and Cotrimoxazole. The mean zone of inhibition recorded against Staphlococcus aureus by using Amoxacillin antibiotic is 2.20mm while with Citrobacter freundii is 1.00. DOI: http://dx.doi.org/10.3126/ije.v3i3.11066 International Journal of Environment Vol.3(3 2014: 89-103

  1. Effect of a protected sleep period on hours slept during extended overnight in-hospital duty hours among medical interns: a randomized trial.

    Science.gov (United States)

    Volpp, Kevin G; Shea, Judy A; Small, Dylan S; Basner, Mathias; Zhu, Jingsan; Norton, Laurie; Ecker, Adrian; Novak, Cristina; Bellini, Lisa M; Dine, C Jessica; Mollicone, Daniel J; Dinges, David F

    2012-12-05

    A 2009 Institute of Medicine report recommended protected sleep periods for medicine trainees on extended overnight shifts, a position reinforced by new Accreditation Council for Graduate Medical Education requirements. To evaluate the feasibility and consequences of protected sleep periods during extended duty. Randomized controlled trial conducted at the Philadelphia VA Medical Center medical service and Oncology Unit of the Hospital of the University of Pennsylvania (2009-2010). Of the 106 interns and senior medical students who consented, 3 were not scheduled on any study rotations. Among the others, 44 worked at the VA center, 16 at the university hospital, and 43 at both. Twelve 4-week blocks were randomly assigned to either a standard intern schedule (extended duty overnight shifts of up to 30 hours; equivalent to 1200 overnight intern shifts at each site), or a protected sleep period (protected time from 12:30 AM to 5:30 AM with handover of work cell phone; equivalent to 1200 overnight intern shifts at each site). Participants were asked to wear wrist actigraphs and complete sleep diaries. Primary outcome was hours slept during the protected period on extended duty overnight shifts. Secondary outcome measures included hours slept during a 24-hour period (noon to noon) by day of call cycle and Karolinska sleepiness scale. For 98.3% of on-call nights, cell phones were signed out as designed. At the VA center, participants with protected sleep had a mean 2.86 hours (95% CI, 2.57-3.10 hours) of sleep vs 1.98 hours (95% CI, 1.68-2.28 hours) among those who did not have protected hours of sleep (P sleep had a mean 3.04 hours (95% CI, 2.77-3.45 hours) of sleep vs 2.04 hours (95% CI, 1.79-2.24) among those who did not have protected sleep (P sleep were significantly less likely to have call nights with no sleep: 5.8% (95% CI, 3.0%-8.5%) vs 18.6% (95% CI, 13.9%-23.2%) at the VA center (P sleep period while on call resulted in an increase in overnight sleep duration

  2. A randomized control trial to evaluate the effect of adjuvant selective laser trabeculoplasty versus medication alone in primary open-angle glaucoma: preliminary results

    Directory of Open Access Journals (Sweden)

    Lee JWY

    2014-09-01

    Full Text Available Jacky WY Lee,1,2 Catherine WS Chan,2 Mandy OM Wong,3 Jonathan CH Chan,3 Qing Li,2 Jimmy SM Lai2 1The Department of Ophthalmology, Caritas Medical Centre, 2The Department of Ophthalmology, The University of Hong Kong, 3The Department of Ophthalmology, Queen Mary Hospital, Hong Kong Background: The objective of this study was to investigate the effects of adjuvant selective laser trabeculoplasty (SLT versus medication alone on intraocular pressure (IOP control, medication use, and quality of life in patients with primary open-angle glaucoma.Methods: This prospective, randomized control study recruited 41 consecutive primary open-angle glaucoma subjects with medically-controlled IOP ≤21 mmHg. The SLT group (n=22 received a single 360-degree SLT treatment. The medication-only group (n=19 continued with their usual treatment regimen. In both groups, medication was titrated to maintain a target IOP defined as a 25% reduction from baseline IOP without medication, or <18 mmHg, whichever was lower. Outcomes, which were measured at baseline and at 6 months, included the Glaucoma Quality of Life-15 (GQL-15 and Comparison of Ophthalmic Medications for Tolerability (COMTOL survey scores, IOP, and the number of antiglaucoma medicines. Results: The baseline IOP was 15.8±2.7 mmHg and 14.5±2.5 mmHg in the SLT and medication-only groups, respectively (P=0.04. Both groups had a comparable number of baseline medication (P=0.2, GQL-15 (P=0.3 and COMTOL scores (P=0.7. At 6 months, the SLT group had a lower IOP (P=0.03 and required fewer medications compared with both baseline (P<0.0001 and with the medication-only group (P=0.02. There was no statistically significant difference in the 6-month GQL-15 or COMTOL score as compared to baseline (P≥0.4 or between the two treatment groups (P≥0.2.Conclusion: A single session of adjuvant SLT provided further reductions in IOP and medication without substantial changes in quality of life or medication tolerability at 6

  3. Prophylactic versus clinically-driven antibiotics in comatose survivors of out-of-hospital cardiac arrest-A randomized pilot study.

    Science.gov (United States)

    Ribaric, Suada Filekovic; Turel, Matjaz; Knafelj, Rihard; Gorjup, Vojka; Stanic, Rade; Gradisek, Primoz; Cerovic, Ognjen; Mirkovic, Tomislav; Noc, Marko

    2017-02-01

    To investigate benefits of prophylactic antibiotics in comatose survivors of out-of-hospital cardiac arrest (OHCA). Patients without evidence of tracheobronchial aspiration on admission bronchoscopy were randomized to prophylactic Amoxicillin-Clavulanic acid 1.2g every 8h (P) or clinically-driven antibiotics (C) administered if signs of infection developed during initial 7days of intensive care unit (ICU) stay. Among 83 patients enrolled between September 2013 and February 2015, tracheobronchial aspiration was documented in 23 (28%). Accordingly, 60 patients were randomized. Percentage of patients on antibiotics between days 1-5 was significantly greater in P group. White blood count, C-reactive protein, procalcitonin (PCT) and CD 64 significantly increased during the postresuscitation phase. Except for lower CRP and PCT in group P on day 6 (p<0.05), there was no significant differences. Mini BAL on day 3 was less often positive in group P (7% vs. 42%; p<0.01). There was no significant difference in other microbiological samples and X-ray signs of pneumonia cumulatively documented in 50% in both groups. Use of vasopressors/inotropes (93% in both groups), duration of mechanical ventilation (5.4±3.7 vs. 5.2±3.1 days), tracheal intubation (6.5±4.6 vs. 5.9±4.3 days), ICU stay (7.7±5.2 vs. 6.9±4.5 days), survival (73% vs. 73%) and survival with good neurological outcome (50% vs. 40%) were also comparable between P and C groups. Bronchoscopy on admission documented tracheobronchial aspiration in 28% of comatose survivors of OHCA. In the absence of aspiration, prophylactic antibiotics did not significantly alter systemic inflammatory response, postresuscitation pneumonia, ICU treatment and outcome (ClinicalTrials.gov Identifier: NCT02899507). Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Effectiveness of health education intervention in improving knowledge, attitude, and practices regarding Tuberculosis among HIV patients in General Hospital Minna, Nigeria - A randomized control trial.

    Science.gov (United States)

    Bisallah, Chindo Ibrahim; Rampal, Lekhraj; Lye, Munn-Sann; Mohd Sidik, Sherina; Ibrahim, Normala; Iliyasu, Zubairu; Onyilo, Michael Ochigbo

    2018-01-01

    The risk of development of active TB in HIV-infected individuals is 20-37 times higher than those that are HIV negative. Poor knowledge of TB amongst people living with HIV has been associated with high transmission. To determine the effectiveness of a new health education intervention module in improving knowledge, attitude, and practice (KAP) regarding tuberculosis among HIV patients in General Hospital Minna, Nigeria. A randomized control trial was carried out from July 2015 to June 2017. A random number generating program was used to allocate 226 respondents into 2 groups. The intervention group received health education regarding tuberculosis using the developed module. The control group received the normal services provided for HIV patients. Data were collected from December 2015 to September 2016 at baseline, immediate post intervention, three, six and nine months. The outcome measures were knowledge, attitude, and practice. There was no significant difference with respect to socio-demographic characteristics, KAP of the respondents in the intervention and control group at baseline. However, there was significant improvement in knowledge in the intervention group compared to the control group, group main effect (F = (1,218) = 665.889, p = 0.001, partial ἠ2 = 0.753, d = 5.4); time (F = (3.605, 218) = 52.046, p = 0.001, partial ἠ2 = 0.193, d = 1.52) and interaction between group with time (F = (3.605, 218) = 34.028, p = 0.001, partial ἠ2 = 0.135, d = 1.23). Likewise, there was significant improvement in attitude, group main effect (p = 0.001, d = 1.26) and time (p = 0.001, p, d = 0.65). Similarly, there was improvement in practice, group main effect, time, and interaction of group with time (p < 0.05). The health education intervention program was effective in improving KAP regarding tuberculosis among HIV patients.

  5. Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders

    DEFF Research Database (Denmark)

    Nordentoft, Merete; Øhlenschlæger, Johan; Thorup, Anne Amalie Elgaard

    2010-01-01

    in a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or hospital-based rehabilitation. RESULTS: It was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in psychiatric wards...... on use of institutional care of different intensive interventions for patients with first-episode schizophrenia spectrum disorder on use of psychiatric bed days and days in supported housing.MethodA total of 94 severely ill patients with first-episode schizophrenia spectrum disorders were included...... and in supported housing throughout the 5-year follow-up period compared with the two other groups. Patients in OPUS treatment spent significantly fewer days in psychiatric wards and supported housing in the first 3 years compared with patients in hospital-based rehabilitation. Due to attrition and small sample...

  6. Antibiotic resistance, ability to form biofilm and susceptibility to copper alloys of selected staphylococcal strains isolated from touch surfaces in Polish hospital wards.

    Science.gov (United States)

    Różańska, Anna; Chmielarczyk, Agnieszka; Romaniszyn, Dorota; Bulanda, Małgorzata; Walkowicz, Monika; Osuch, Piotr; Knych, Tadeusz

    2017-01-01

    Despite the employment of sanitary regimes, contact transmission of the aetiological agents of hospital infections is still exceedingly common. The issue of microbe transmission becomes particularly important when facing multidrug-resistant microorganisms such as methicillin-resistant staphylococci. In the case of deficiencies in cleaning and disinfection procedures, hospital equipment made of copper alloys can play an important role, complementing traditional hospital hygiene procedures. The objective of this study was to characterize staphylococcal strains isolated from touch surfaces in Polish hospital wards in terms of their drug resistance, ability to form biofilm and susceptibility to antimicrobial activity of copper alloys. The materials for the study were 95 staphylococcal strains isolated from touch surfaces in 13 different hospital wards from Małopolska province (the south of Poland). Phenotypic and genotypic antibiotic resistance were checked for erythromycin, clindamycin, gentamycin, ciprofloxacin, trimethoprim/sulfamethoxazole and mupirocin. Biofilm formation ability for the tested strains was checked with the use of culture on Congo red agar. Susceptibility to copper, tin bronze, brass and new silver was tested using a modification of the Japanese standard. Over 67% of the analysed staphylococcal strains were methicillin-resistant (MR). Four strains were resistant to all of the tested antibiotics, and 14 were resistant to all except mupirocin. Strains classified as MR had significantly increased resistance to the remaining antibiotic groups. About one-third of the analysed strains revealed biofilm-forming ability. Among the majority of species, biofilm-forming and non-biofilm-forming strains were distributed evenly; in the case of S. haemolyticus only, negative strains accounted for 92.8%. Susceptibility to copper alloys was different between strains and rather lower than in the case of the SA strain selected for comparison. Coagulase

  7. Effect of Spike Lavender Lakhlakhe on Pain Intensity Due to Phlebotomy Procedure in Premature Infants Hospitalized in Neonatal Intensive Care Unit: A Randomized Clinical Trial

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    Noushin Beheshtipoor

    2017-06-01

    Full Text Available Background: A Premature infants undergo multiple painful procedures during treatment; thus, it must be tried to limit complications caused by diagnostic and treatment procedures using simple and practical methods. This study was performed to evaluate the effect of spike lavender lakhlakhe on pain intensity due to phlebotomy in hospitalized premature infants.Methods: This single-arm, randomized clinical trial was performed on 30 infants chosen through convenience sampling method. Each newborn was considered as its own control. For the test group, one drop of pure (100% spike lavender lakhlakhe was taken by a standard dropper and diluted with 4 ml of warm distilled water by the research assistant. This mixture was stirred at 2-3 cm distance of the newborns’ nose from 60 minutes before until 2 minutes after phlebotomy, such that it could be smelled by the newborns. In both groups, heart rate and blood oxygen saturation were measured by a standard portable device, and the corresponding data was recorded in data collection sheets. Moreover, the infants’ facial expression changes were recorded by a camera and the intensity of pain was measured by Premature Infant Pain Profile before and after the procedure. Finally, the data was analyzed by paired comparison analysis test in SPSS, version 17.Results: Comparison of mean pain intensity caused by phlebotomy in the control and test groups showed a significant difference (7.667±0.311 vs. 4.882±0.311; P

  8. [Effectiveness of microcurrent therapy as a constituent of post-hospital rehabilitative treatment in patients after total knee alloarthroplasty - a randomized clinical trial].

    Science.gov (United States)

    Rockstroh, G; Schleicher, W; Krummenauer, F

    2010-06-01

    This trial compared the clinical effectiveness of a combination of microcurrent therapy (M) with conventional postoperative physiotherapy treatment versus the combination of the latter with a sham (S) treatment after total knee arthroplasty (TKA) in terms of patient-related functional outcome parameters. A total of 78 inpatients after TKA was randomized into the active versus the sham treatment samples; all patients received ten applications of their respective therapy assignment. The primary clinical endpoint of the investigation was defined as the three-months intraindividual change (%) in a patient's OSWESTRY total function score after start of treatment. Secondary endpoints were the WOMAC osteoarthritis index as well as a patient's pain profile as assessed by a visual analogue scale before start of treatment, after five and ten therapeutic applications, and three months after discharge from hospital. The M sample showed a median increase of 31% (22-38%) in the OSWESTRY total score from 53% before start of treatment to 91% three months afterwards; the control sample showed an increase of 18% (3-31%) in median from 56 % to 78%; the samples differed significantly in this three-months increase (pmicrocurrent therapy embedded in conventional postoperative rehabilitation treatment after TKA versus the combination with a sham treatment. The results indicate an early introduction of microcurrent therapy concepts into postoperative treatment. Georg Thieme Verlag KG Stuttgart New York.

  9. Is reiki or prayer effective in relieving pain during hospitalization for cesarean? A systematic review and meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Guilherme Augusto Rago Ferraz

    2017-04-01

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: This systematic review compared reiki and prayer with drug use for relieving pain during hospitalization for cesarean, given that the popularity of integrative medicine and spiritual healing has been increasing. It had the aim of evaluating whether reiki or prayer is effective in relieving pain during cesarean section. DESIGN AND SETTING: Systematic review with meta-analysis conducted at Botucatu Medical School, UNESP, São Paulo, Brazil. METHODS: The following databases were searched up to March 2016: MEDLINE, Embase, LILACS and CENTRAL. Randomized controlled trials published in English or Portuguese were included in the review. Two reviewers independently screened eligible articles, extracted data and assessed the risk of bias. A GRADE table was produced to evaluate the risk of bias. RESULTS: There was evidence with a high risk of bias showing a statistically significant decrease in pain score through use of reiki and prayer, in relation to the protocol group: mean difference = -1.68; 95% confidence interval: -1.92 to -1.43; P < 0.00001; I2 = 92%. Furthermore, there was no statistically significant difference in heart rate or systolic or diastolic blood pressure. CONCLUSION: Evidence with a high risk of bias suggested that reiki and prayer meditation might be associated with pain reduction.

  10. Is reiki or prayer effective in relieving pain during hospitalization for cesarean? A systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Ferraz, Guilherme Augusto Rago; Rodrigues, Meline Rosseto Kron; Lima, Silvana Andrea Molina; Lima, Marcelo Aparecido Ferraz; Maia, Gabriela Lopes; Pilan, Carlos Alberto; Omodei, Michelle Sako; Molina, Ana Cláudia; El Dib, Regina; Rudge, Marilza Vieira Cunha

    2017-01-01

    This systematic review compared reiki and prayer with drug use for relieving pain during hospitalization for cesarean, given that the popularity of integrative medicine and spiritual healing has been increasing. It had the aim of evaluating whether reiki or prayer is effective in relieving pain during cesarean section. Systematic review with meta-analysis conducted at Botucatu Medical School, UNESP, São Paulo, Brazil. The following databases were searched up to March 2016: MEDLINE, Embase, LILACS and CENTRAL. Randomized controlled trials published in English or Portuguese were included in the review. Two reviewers independently screened eligible articles, extracted data and assessed the risk of bias. A GRADE table was produced to evaluate the risk of bias. There was evidence with a high risk of bias showing a statistically significant decrease in pain score through use of reiki and prayer, in relation to the protocol group: mean difference = -1.68; 95% confidence interval: -1.92 to -1.43; P reiki and prayer meditation might be associated with pain reduction.

  11. Affinity selection of Nipah and Hendra virus-related vaccine candidates from a complex random peptide library displayed on bacteriophage virus-like particles

    Energy Technology Data Exchange (ETDEWEB)

    Peabody, David S.; Chackerian, Bryce; Ashley, Carlee; Carnes, Eric; Negrete, Oscar

    2017-01-24

    The invention relates to virus-like particles of bacteriophage MS2 (MS2 VLPs) displaying peptide epitopes or peptide mimics of epitopes of Nipah Virus envelope glycoprotein that elicit an immune response against Nipah Virus upon vaccination of humans or animals. Affinity selection on Nipah Virus-neutralizing monoclonal antibodies using random sequence peptide libraries on MS2 VLPs selected peptides with sequence similarity to peptide sequences found within the envelope glycoprotein of Nipah itself, thus identifying the epitopes the antibodies recognize. The selected peptide sequences themselves are not necessarily identical in all respects to a sequence within Nipah Virus glycoprotein, and therefore may be referred to as epitope mimics VLPs displaying these epitope mimics can serve as vaccine. On the other hand, display of the corresponding wild-type sequence derived from Nipah Virus and corresponding to the epitope mapped by affinity selection, may also be used as a vaccine.

  12. AN ASSESSMENT OF COOPERATIVE LEARNING EFFECTIVENESS IN TOURISM AND HOSPITALITY TEACHING – A CASE STUDY OF SELECTED STUDENT GROUPS AT STRATHMORE UNIVERSITY IN KENYA

    Directory of Open Access Journals (Sweden)

    Joe Kibuye Wadawi

    2013-09-01

    Full Text Available Cooperative Learning has been defined as a relationship in a group of students that requires positive interdependence, individual accountability, interpersonal skills, face-to-face promotive interaction, and processing. Several techniques have been used to implement to advance learning amongst groups of tourism and hospitality students. While a number of methods have delivered favourable results in students’ motivation and learning, some have been used with counterproductive results. The purpose of this study therefore was to carry out a practical assessment of a specified cooperative learning technique using selected student groups within the School of Tourism and Hospitality in Strathmore University, Kenya. In this study, identified learning groups were given fundamental rules on how to use the chosen technique and thereafter asked to apply the technique in a specified learning session. Students were then asked to complete a simple questionnaire to make judgement on the learning effectiveness of the technique and their attitude to it regarding group dynamics. This study established that there are aspects typical of cooperative learning that should be encouraged and specific aspects that should be discouraged. The research identified major factors that should be considered to enhance cooperative learning in tourism and hospitality education in Africa

  13. PREVALENCE OF ANTI- Toxocara ANTIBODIES IN A RANDOM SAMPLE OF INPATIENTS AT A CHILDREN'S HOSPITAL IN VITÓRIA, ESPÍRITO SANTO, BRAZIL

    Directory of Open Access Journals (Sweden)

    Sandra F. MOREIRA-SILVA

    1998-07-01

    Full Text Available In the streets of Vitória, in the State of Espírito Santo, Brazil, are large number of stray dogs, many of which are infected with Toxocara canis, suggesting a high risk for human infection. In order to investigate the prevalence of Toxocara infection in children in Espírito Santo we studied the prevalence of anti-Toxocara antibodies in 100 random inpatients over one year of age, at the Children's Hospital N.S. da Glória, the reference children's hospital for the State.All the sera were collected during the period between October 1996 and January 1997. The mean age was 6.6±4.1 yrs. (1 to 14 yrs., median 6yrs. and there were patients from all of the different wards of the hospital. Sixty-eigth patients came from the metropolitan area of Vitória and the other 32 from 17 other municipalities. The anti-Toxocara antibodies were investigated by ELISA-IgG using a secretory-excretory antigen obtained from second stage larvae. All sera were adsorbed with Ascaris suum antigen before the test. Thirty-nine sera (39% were positive, predominantly from boys, but the gender difference was not statistically significant (boys:25/56 or 44.6%; girls:14/44 or 31.8%; p=0.311. The prevalence of positive sera was higher, but not statistically significant, in children from the urban periphery of metropolitan Vitória (formed by the cities of Vitória, Cariacica, Vila Velha, Serra and Viana than in children from 17 other municipalities (44.1% and 28.1% respectively, p=0.190. Although the samples studied do not represent all children living in the State of Espírito Santo, since the Children's Hospital N.S. da Glória admits only patients from the state health system, it is probable that these results indicate a high frequency of Toxocara infection in children living in Espírito Santo. Further studies of population samples are necessary to ascertain the prevalence of Toxocara infection in our country.Em Vitória é grande o número de cães soltos nas ruas, muitos

  14. Indoor air pollution (PM2.5) due to secondhand smoke in selected hospitality and entertainment venues of Karachi, Pakistan.

    Science.gov (United States)

    Nafees, Asaad Ahmed; Taj, Tahir; Kadir, Muhammad Masood; Fatmi, Zafar; Lee, Kiyoung; Sathiakumar, Nalini

    2012-09-01

    To determine particulate matter smaller than 2.5 μm (PM(2.5)) levels at various hospitality and entertainment venues of Karachi, Pakistan. This was a descriptive cross-sectional study conducted at various locations in Karachi, during July 2009. Sampling was performed at 20 enclosed public places, including hospitality (restaurants and cafés) and entertainment (snooker/billiard clubs and gaming zones) venues. PM(2.5) levels were measured using an aerosol monitor. All entertainment venues had higher indoor PM(2.5) levels as compared to the immediate outdoors. The indoor PM(2.5) levels ranged from 25 to 390 μg/m(3) and the outdoor PM(2.5) levels ranged from 18 to 96 μg/m(3). The overall mean indoor PM(2.5) level was 138.8 μg/m(3) (± 112.8). Among the four types of venues, the highest mean indoor PM(2.5) level was reported from snooker/billiard clubs: 264.7 μg/m(3) (± 85.4) and the lowest from restaurants: 66.4 μg/m(3) (± 57.6) while the indoor/outdoor ratio ranged from 0.97 to 10.2, highest being at the snooker/billiard clubs. The smoking density ranged from 0.21 to 0.57, highest being at gaming zones. The indoor PM(2.5) concentration and smoking density were not significantly correlated (Spearman's correlation coefficient = 0.113; p = 0.636). This study demonstrates unacceptably high levels of PM(2.5) exposure associated with secondhand smoke (SHS) at various entertainment venues of Karachi even after 8 years since the promulgation of smoke-free ordinance (2002) in Pakistan; however, better compliance may be evident at hospitality venues. The results of this study call for effective implementation and enforcement of smoke-free environment at public places in the country.

  15. Knowledge and attitudes of HIV-infected patients on antiretroviral therapy regarding adverse drug reactions (ADRs in selected hospitals in Nigeria

    Directory of Open Access Journals (Sweden)

    Kenneth Anene Agu

    2012-01-01

    Full Text Available Purpose: The study evaluated the knowledge and attitudes of HIV-infected patients on ART regarding ADRs following routine patient counseling and education in selected hospitals in Nigeria. Materials and Methods: From 36,459 HIV-infected patients on ART in the 36 selected hospitals, a study-specific instrument was administered to 3,650 patients in a cross-sectional study. Patients were provided counseling and education on ADRs before and after commencing ART. Factor analysis was performed using principal components extraction. Item score means above midpoint (3.7 on a 5-point scale were regarded as positive attitudes and below as negative attitudes. A chi-square test was used for inferential statistics; P3.7 which denotes positive attitudes to ADRs. Three extracted factors accounted for 73.1% of cumulative variability. All attitude items had very significant loadings of ≥0.5. Conclusion: Overall, participants reported good knowledge and positive attitudes to adverse effects of their medicines compared to what was reported previously. The patient counseling and education on drug therapy provided to patients may have contributed to these findings and are highly recommended.

  16. YouTube Videos to Create a "Virtual Hospital Experience" for Hip and Knee Replacement Patients to Decrease Preoperative Anxiety: A Randomized Trial.

    Science.gov (United States)

    O'Connor, Mary I; Brennan, Katharyn; Kazmerchak, Shari; Pratt, Jason

    2016-04-18

    With declining reimbursement to health care systems, face-to-face time between patients and providers to optimize preoperative education and counseling may be challenging. Because high patient anxiety prior to surgery has been linked to more severe and persistent pain after joint replacement surgery, the Orthopedic Surgery Department at Mayo Clinic in Florida created a playlist of 16 YouTube videos aimed at creating a virtual hospital experience for primary total hip and knee joint replacement patients. A randomized trial was then performed to evaluate the potential impact of viewing this playlist on preoperative anxiety. Each patient completed a Generalized Anxiety Disorder (GAD) score assessment at the time of the routine preoperative clinic visit and then randomized based on his/her gender, type of surgery, and initial GAD score to either the control group of standard education (education at face-to-face clinical visits as well as printed educational materials) or the treatment group (standard education plus access to the YouTube playlist). On the morning of the patient's surgery, the same survey was repeated. Of the 65 patients who consented to participate in the study, 53 completed the study (82%) with 28 of 29 (97% completed) in the control group and 25 of 36 (69% completed) in the treatment group. Overall, the results showed a trend toward less anxiety in patients who viewed the YouTube videos; this was exhibited by a reduction in the median GAD score by 1 point. This trend is more clearly present in patients with high preoperative anxiety (predominantly women), as seen in the reduction of the median GAD score by 6 points in the treatment group. Although our experience is limited, our results indicate that a series of tailored videos may decrease patient anxiety preoperatively. We recommend further exploration of both this concept and the use of social media tools in preoperative patient education. Clinicaltrials.gov NCT02546180; http

  17. Bias in the prediction of genetic gain due to mass and half-sib selection in random mating populations

    Directory of Open Access Journals (Sweden)

    José Marcelo Soriano Viana

    2009-01-01

    Full Text Available The prediction of gains from selection allows the comparison of breeding methods and selection strategies, although these estimates may be biased. The objective of this study was to investigate the extent of such bias in predicting genetic gain. For this, we simulated 10 cycles of a hypothetical breeding program that involved seven traits, three population classes, three experimental conditions and two breeding methods (mass and half-sib selection. Each combination of trait, population, heritability, method and cycle was repeated 10 times. The predicted gains were biased, even when the genetic parameters were estimated without error. Gain from selection in both genders is twice the gain from selection in a single gender only in the absence of dominance. The use of genotypic variance or broad sense heritability in the predictions represented an additional source of bias. Predictions based on additive variance and narrow sense heritability were equivalent, as were predictions based on genotypic variance and broad sense heritability. The predictions based on mass and family selection were suitable for comparing selection strategies, whereas those based on selection within progenies showed the largest bias and lower association with the realized gain.

  18. Improving end-of-life care in acute geriatric hospital wards using the Care Programme for the Last Days of Life: study protocol for a phase 3 cluster randomized controlled trial.

    Science.gov (United States)

    Verhofstede, Rebecca; Smets, Tinne; Cohen, Joachim; Costantini, Massimo; Van Den Noortgate, Nele; Deliens, Luc

    2015-02-22

    The Care Programme for the Last Days of Life has been developed to improve the quality of end-of-life care in acute geriatric hospital wards. The programme is based on existing end-of-life care programmes but modeled to the acute geriatric care setting. There is a lack of evidence of the effectiveness of end-of-life care programmes and the effects that may be achieved in patients dying in an acute geriatric hospital setting are unknown. The aim of this paper is to describe the research protocol of a cluster randomized controlled trial to evaluate the effects of the Care Programme for the Last Days of Life. A cluster randomized controlled trial will be conducted. Ten hospitals with one or more acute geriatric wards will conduct a one-year baseline assessment during which care will be provided as usual. For each patient dying in the ward, a questionnaire will be filled in by a nurse, a physician and a family carer. At the end of the baseline assessment hospitals will be randomized to receive intervention (implementation of the Care Programme) or no intervention. Subsequently, the Care Programme will be implemented in the intervention hospitals over a six-month period. A one-year post-intervention assessment will be performed immediately after the baseline assessment in the control hospitals and after the implementation period in the intervention hospitals. Primary outcomes are symptom frequency and symptom burden of patients in the last 48 hours of life. This will be the first cluster randomized controlled trial to evaluate the effect of the Care Programme for the Last Days of Life for the acute geriatric hospital setting. The results will enable us to evaluate whether implementation of the Care Programme has positive effects on end-of-life care during the last days of life in this patient population and which components of the Care Programme contribute to improving the quality of end-of-life care. ClinicalTrials.gov Identifier: NCT01890239. Registered June 24th

  19. Significance of personality disorders in the face of drop-outs from psychiatric hospitalizations. The case of selected psychiatric units.

    Science.gov (United States)

    Biała, Maja; Kiejna, Andrzej

    2017-06-18

    The World Health Organization's estimations indicate that about 50% of patients in well-developed countries may not adhere to long-term therapies. In the field of psychiatry, drop-outs from psychiatric treatment are particularly important. Personality disorders are a significant part of this sphere. The aim of this research was to empirically verify the hypothesis regarding the relation between comorbid personality disorders and drop-outs from treatment among patients of psychiatric wards. This study was a prospective cohort study. 110 patients, hospitalized in 3 different psychiatric wards, were included. Personality disorders were assessed with the Structured Clinical Interview For DSM-IV Personality Disorders (SCID-II). The research was financed by the Polish National Science Center (DEC-2011/01/N/NZ5/05364). The response rate was 89.1%. 72.56% of patients suffered from personality disorders (SCID-II) (among them the most prevalent were: personality disorder - not otherwise specified - 40.7% and borderline personality disorder - 12.38%; 22.95% of patients dropped out from treatment). However, occurrence of personality disorders was not relevant for those drop-outs. On the other hand, relationships at the level of certain criteria of borderline personality disorders and passive-aggressive personality have been revealed. These relationships became stronger when considered from the perspective of differences in the organization of treatment at individual wards. Some personality disorders may play an important role in drop-outs from psychiatric treatment. Presented results require further research.

  20. Expressed sequence tags of randomly selected cDNA clones from Eucalyptus globulus-Pisolithus tinctorius ectomycorrhiza.

    Science.gov (United States)

    Tagu, D; Martin, F

    1995-01-01

    Random sequencing of cDNA clones from Eucalyptus globulus-Pisolithus tinctorius ectomycorrhizal tissues was carried out to generate expressed sequence tags (ESTs). Database comparisons revealed that 42% of the cDNAs corresponded to previously sequenced genes. These ESTs represent efficient molecular markers to analyze changes in gene expression during the formation of the ectomycorrhizal symbiosis.

  1. Gastrointestinal tolerance and plasma status of carotenoids, EPA and DHA with a fiber-enriched tube feed in hospitalized patients initiated on tube nutrition: Randomized controlled trial.

    Science.gov (United States)

    Jakobsen, L H; Wirth, R; Smoliner, C; Klebach, M; Hofman, Z; Kondrup, J

    2017-04-01

    During the first days of tube feeding (TF) gastrointestinal (GI) complications are common and administration of sufficient nutrition is a challenge. Not all standard nutritionally complete formulas contain dietary fiber, fish oil or carotenoids, key dietary nutrients for health and wellbeing. The aim of this study was to investigate the effects of a fiber, fish oil and carotenoid enriched TF formula on diarrhea, constipation and nutrient bioavailability. A multi-center randomized, double-blind, controlled, parallel trial compared the effects of a dietary fiber, fish oil and carotenoid-enriched TF formula (test) with an isocaloric non-enriched formula (control) in 51 patients requiring initiation of TF. Incidence of diarrhea and constipation (based on stool frequency and consistency) was recorded daily. Plasma status of EPA, DHA and carotenoids was measured after 7 days. The incidence of diarrhea was lower in patients receiving the test formula compared with the control group (19% vs. 48%, p = 0.034). EPA and DHA status (% of total plasma phospholipids) was higher after 7 days in test compared with control group (EPA: p = 0.002, DHA: p = 0.082). Plasma carotenoid levels were higher after 7 days in the test group compared with control group (lutein: p = 0.024, α-carotene: p = 0.005, lycopene: p = 0.020, β-carotene: p = 0.054). This study suggests that the nutrient-enriched TF formula tested might have a positive effect on GI tolerance with less diarrhea incidence and significantly improved EPA, DHA and carotenoid plasma levels during the initiation of TF in hospitalized patients who are at risk of diarrhea and low nutrient status. This trial was registered at trialregister.nl; registration number 2924. Copyright © 2016. Published by Elsevier Ltd.

  2. Comparing Patients' Opinions on the Hospital Discharge Process Collected With a Self-Reported Questionnaire Completed Via the Internet or Through a Telephone Survey: An Ancillary Study of the SENTIPAT Randomized Controlled Trial.

    Science.gov (United States)

    Couturier, Berengere; Carrat, Fabrice; Hejblum, Gilles

    2015-06-24

    Hospital discharge, a critical stage in the hospital-to-home transition of patient care, is a complex process with potential dysfunctions having an impact on patients' health on their return home. No study has yet reported the feasibility and usefulness of an information system that would directly collect and transmit, via the Internet, volunteer patients' opinions on their satisfaction concerning the organization of hospital discharge. Our primary objective was to compare patients' opinions on the discharge process collected with 2 different methods: self-questionnaire completed on a dedicated website versus a telephone interview. The secondary goal was to estimate patient satisfaction. We created a questionnaire to examine hospital discharge according to 3 dimensions: discharge logistics organization, preplanned posthospital continuity-of-care organization, and patients' impressions at the time of discharge. A satisfaction score (between 0 and 1) for each of those dimensions and an associated total score were calculated. Taking advantage of the randomized SENTIPAT trial that questioned patients recruited at hospital discharge about the evolution of their health after returning home and randomly assigned them to complete a self-questionnaire directly online or during a telephone interview, we conducted an ancillary study comparing satisfaction with the organization of hospital discharge for these 2 patient groups. The questionnaire was proposed to 1141 patients included in the trial who were hospitalized for ≥2 days, among whom 867 eligible patients had access to the Internet at home and were randomized to the Internet or telephone group. Of the 1141 patients included, 755 (66.17%) completed the questionnaire. The response rates for the Internet (39.1%, 168/430) and telephone groups (87.2%, 381/437) differed significantly (PInternet requires patients' active participation and those planning surveys in the domain explored in this study should anticipate a lower

  3. Impact of Selection Bias on Treatment Effect Size Estimates in Randomized Trials of Oral Health Interventions: A Meta-epidemiological Study.

    Science.gov (United States)

    Saltaji, H; Armijo-Olivo, S; Cummings, G G; Amin, M; da Costa, B R; Flores-Mir, C

    2018-01-01

    Emerging evidence suggests that design flaws of randomized controlled trials can result in over- or underestimation of the treatment effect size (ES). The objective of this study was to examine associations between treatment ES estimates and adequacy of sequence generation, allocation concealment, and baseline comparability among a sample of oral health randomized controlled trials. For our analysis, we selected all meta-analyses that included a minimum of 5 oral health randomized controlled trials and used continuous outcomes. We extracted data, in duplicate, related to items of selection bias (sequence generation, allocation concealment, and baseline comparability) in the Cochrane Risk of Bias tool. Using a 2-level meta-meta-analytic approach with a random effects model to allow for intra- and inter-meta-analysis heterogeneity, we quantified the impact of selection bias on the magnitude of ES estimates. We identified 64 meta-analyses, including 540 randomized controlled trials analyzing 137,957 patients. Sequence generation was judged to be adequate (at low risk of bias) in 32% ( n = 173) of trials, and baseline comparability was judged to be adequate in 77.8% of trials. Allocation concealment was unclear in the majority of trials ( n = 458, 84.8%). We identified significantly larger treatment ES estimates in trials that had inadequate/unknown sequence generation (difference in ES = 0.13; 95% CI: 0.01 to 0.25) and inadequate/unknown allocation concealment (difference in ES = 0.15; 95% CI: 0.02 to 0.27). In contrast, baseline imbalance (difference in ES = 0.01, 95% CI: -0.09 to 0.12) was not associated with inflated or underestimated ES. In conclusion, treatment ES estimates were 0.13 and 0.15 larger in trials with inadequate/unknown sequence generation and inadequate/unknown allocation concealment, respectively. Therefore, authors of systematic reviews using oral health randomized controlled trials should perform sensitivity analyses based on the adequacy of

  4. Cervical Cancer Prevention Knowledge and Attitudes among Female University Students and Hospital Staff in Iran

    OpenAIRE

    Asgarlou, Zoleykha; Tehrani, Sepideh; Asghari, Elnaz; Arzanlou, Mohammad; Naghavi-Behzad, Mohammad; Piri, Reza; Sheyklo, Sepideh Gareh; Moosavi, Ahmad

    2016-01-01

    Background: Cervical cancer is a major preventable cancers. The, current study aimed to assess relevant knowledge and attitude of female students and hospital staff in Iran. Method: This cross-sectional study was conducted in Medical and Nursing faculties and hospitals of East-Azerbaijan Province of Iran. Participants were medical and paramedical female students and female staff in hospitals selected by stratified random sampling techniques. Tools for data collection were questionnaires for w...

  5. Medication Errors in Hospitals: A Study of Factors Affecting Nursing Reporting in a Selected Center Affiliated with Shahid Beheshti University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    HamidReza Mirzaee

    2015-10-01

    Full Text Available Background: Medication errors are mentioned as the most common important challenges threatening healthcare system in all countries worldwide. This study is conducted to investigate the most significant factors in refusal to report medication errors among nursing staff.Methods: The cross-sectional study was conducted on all nursing staff of a selected Education& Treatment Center in 2013. Data was collected through a teacher made questionnaire. The questionnaires’ face and content validity was confirmed by experts and for measuring its reliability test-retest was used. Data was analyzed by descriptive and analytic statistics. 16th  version of SPSS was also used for related statistics.Results: The most important factors in refusal to report medication errors respectively are: lack of reporting system in the hospital(3.3%, non-significance of reporting medication errors to hospital authorities and lack of appropriate feedback(3.1%, and lack of a clear definition for a medication error (3%. there was a significant relationship between the most important factors of refusal to report medication errors and work shift (p:0.002, age(p:0.003, gender(p:0.005, work experience(p<0.001 and employment type of nurses(p:0.002.Conclusion: Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence.

  6. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Rasmussen, Søren

    2008-01-01

    follow-up for 10.5 months. RESULTS: We randomized 380 patients to CCR versus 390 to UC. Randomization was well balanced. The primary outcome occurred in 31% of both groups (relative risk 0.96, 95% confidence interval 0.78-1.26). Compared with the UC group, CCR significantly reduced length of stay by 15......% (95% confidence interval 1.1%-27.1%, P = .04), mean number of cardiac risk factors above target (4.5 vs 4.1, P = .01), patients with systolic blood pressure below target (P = .003), physically inactivity (P = .01), and unhealthy dietary habits (P = .0003). Short-Form-36 and Hospital Anxiety...... and Depression Scale did not differ significantly. CONCLUSION: At 12 months, the CCR and UC groups did not differ regarding the primary composite outcome. Comprehensive cardiac rehabilitation significantly reduced length of hospital stay and improved cardiac risk factors....

  7. A Brief, Web-based Personalized Feedback Selective Intervention for College Student Marijuana Use: A Randomized Clinical Trial

    OpenAIRE

    Lee, Christine M.; Neighbors, Clayton; Kilmer, Jason R; Larimer, Mary E.

    2010-01-01

    Despite clear need, brief web-based interventions for marijuana using college students have not been evaluated in the literature. The current study was designed to evaluate a brief, web-based personalized feedback intervention for at-risk marijuana users transitioning to college. All entering first-year students were invited to complete a brief questionnaire. Participants meeting criteria completed a baseline assessment (N = 341) and were randomly assigned to web-based personalized feedback o...

  8. The Conformity Rate of the Principles of Catheterization Nursing Care in Women with the Standards in Selected Hospital of Qom University of Medical Sciences, 2015, Iran

    Directory of Open Access Journals (Sweden)

    Fahime Rostami Nouri

    2016-07-01

    Full Text Available Background and Objectives: Given the increasing prevalence of use of urinary catheter, nurses as one of the largest and the most important health care provider groups, should have extensive knowledge and skills in order to provide standard health care. This study was conducted to determine the conformity rate of the principles of catheterization nursing care in women with the standards in selected Hospital of Qom University of Medical Sciences, 2015. Methods: In this descriptive cross-sectional study, 195 cases of catheterization nursing care in women, were investigated using event sampling in one of the hospitals affiliated to Qom University of Medical Sciences, in 2015. Data were gathered through Nurses' Demographic Information Questionnaire and checklist of catheterization nursing care in women. Results: In this study, the conformity rate of catheterization nursing care with the standards was 70.8% (moderate; 29.2% of the care was desirable; and 0% was poor. Conclusion: According to the results, nurses’ performance in the catheterization nursing care in women was in moderate level compared to the standards. In order to improve the quality of cares, implementation of nursing clinical guidelines for women catheterization, and clinical supervision by nurse managers, are suggested.  

  9. Knowledge and Practice of Nursing Staff about Sharp Waste Management in Selected Hospitals of Military (Tehran and Non- Military (Qom in 2012

    Directory of Open Access Journals (Sweden)

    Norouz Mohmoudi

    2017-01-01

    Full Text Available Healthcare wastes are a major challenge in public health and comprise all types of wastes generated by healthcare centers, research facilities, and laboratories. The aim of this study was surveying the knowledge and practice of nursing staff about sharp waste management in selected military (Tehran and non- military (Qom hospitals in 2012. This was a descriptive-analytical study on 143 nursing stuff in Military and Non-Military hospitals. Data was collected using a self-report questionnaire. Statistical tests such as the student t-test, one-way analysis of variance and Pearson correlation were used to data analysis. The mean age of participants was 32(±6.3 and the majority were female. The mean score of knowledge was 54.7(±14.4 and their knowledge classified on a moderate level. Also, the mean score of practice was 65.44(±11.6 and was classified on a moderate level. The means of these variables were higher among personnel of Military than Non-Military. There were positive correlations between knowledge, practice and age variables (P

  10. Validity of dementia diagnoses in the Danish hospital registers

    DEFF Research Database (Denmark)

    Phung, Thien Kieu Thi; Andersen, Birgitte Bo; Høgh, Peter

    2007-01-01

    BACKGROUND: The validity of dementia diagnoses in the Danish nationwide hospital registers was evaluated to determine the value of these registers in epidemiological research about dementia. METHODS: Two hundred patients were randomly selected from 4,682 patients registered for the first time wit...

  11. A Randomized Comparative Study of Pulsed Radiofrequency Treatment With or Without Selective Nerve Root Block for Chronic Cervical Radicular Pain.

    Science.gov (United States)

    Wang, Fei; Zhou, Qian; Xiao, Lizu; Yang, Juan; Xong, Donglin; Li, Disen; Liu, LiPing; Ancha, Sigdha; Cheng, Jianguo

    2017-06-01

    We demonstrated a combination of pulsed radiofrequency (PRF) and cervical nerve root block (CNRB) via a posterior approach was superior to a transforaminal epidural steroid injection through the anterolateral approach for cervical radicular pain in a previous study. This randomized trial was conducted to determine the comparative efficacy between CNRB, PRF, and CNRB + PRF for cervical radicular pain. A prospective and randomized design was used in this study. Sixty-two patients were randomized into three parallel groups: CNRB, PRF, or CNRB + PRF. Numeric Rating Scale (NRS) was used to measure pain intensity, and global perceived effect (GPE) was scored by the patient on a 7-point scale, ranging from much worse (-3), no change (0), to total improvement (+3). The outcomes were evaluated at 1 week, 1 month, 3 months, and 6 months. Side effects and complications were noted. The NRS was significantly reduced in all three groups 1 week after the treatments (P 0.05). No serious complications were observed in any of the patients. Combining CNRB and PRF appeared to be a safe and efficacious technique for cervical radicular pain. The combination therapy yielded better outcomes than either CNRB or PRF alone. © 2016 World Institute of Pain.

  12. The effect of intervening hospitalizations on the benefit of structured physical activity in promoting independent mobility among community-living older persons: secondary analysis of a randomized controlled trial.

    Science.gov (United States)

    Gill, Thomas M; Beavers, Daniel P; Guralnik, Jack M; Pahor, Marco; Fielding, Roger A; Hauser, Michelle; Manini, Todd M; Marsh, Anthony P; McDermott, Mary M; Newman, Anne B; Allore, Heather G; Miller, Michael E

    2017-03-28

    Among older persons, disability is often precipitated by intervening illnesses and injuries leading to hospitalization. In the Lifestyle Interventions and Independence for Elders (LIFE) Study, a structured moderate-intensity physical activity program, compared with a health education program, was shown to significantly reduce the amount of time spent with major mobility disability (MMD) over the course of 3.5 years. We aimed to determine whether the benefit of the physical activity program in promoting independent mobility was diminished in the setting of intervening hospitalizations. We analyzed data from a single-blinded, parallel group randomized trial (ClinicalTrials.gov: NCT01072500). In this trial, 1635 sedentary persons, aged 70-89 years, who had functional limitations but were able to walk 400 m, were randomized from eight US centers between February 2010 and December 2013: 818 to physical activity (800 received intervention) and 817 to health education (805 received intervention). Intervening hospitalizations and MMD, defined as the inability to walk 400 m, were assessed every 6 months for up to 3.5 years. For both the physical activity and health education groups, intervening hospitalizations were strongly associated with the initial onset of MMD and inversely associated with recovery from MMD, defined as a transition from initial MMD onset to no MMD. The benefit of the physical activity intervention did not differ significantly based on hospital exposure. For onset of MMD, the hazard ratios (HR) were 0.79 (95% confidence interval [CI] 0.58-1.1) and 0.77 (0.62-0.95) in the presence and absence of intervening hospitalizations, respectively (P-interaction, 0.903). For recovery of MMD, the magnitude of effect was modestly greater among participants who were hospitalized (HR 1.5, 95% CI 0.71-3.0) than in those who were not hospitalized (HR 1.2, 95% CI 0.88-1.7), but this difference did not achieve statistical significance (P-interaction, 0

  13. Impact of participation in randomized trials of reperfusion therapy on the time to reperfusion and hospital mortality in ST-segment elevation myocardial infarction: A single-centre cohort study.

    Science.gov (United States)

    Juliard, Jean-Michel; Golmard, Jean-Louis; Feldman, Laurent J; Himbert, Dominique; Nejjari, Mohammed; Ducrocq, Gregory; Sorbets, Emmanuel; Garbarz, Eric; Aubry, Pierre; Duchatelle, Valérie; Vahanian, Alec; Steg, Ph Gabriel

    2016-04-01

    There is uncertainty as to whether consenting and randomizing patients in randomized clinical trials (RCTs) in acute ST-segment elevation myocardial infarction (STEMI) delays reperfusion and increases mortality. The aim of this study was to determine whether participation of patients with STEMI in RCTs is associated with delay in implementation of reperfusion therapy and increased hospital mortality. A consecutive sample of 2523 patients, admitted within 6 hours of symptom onset without cardiogenic shock, was recruited from a single tertiary academic centre. They were categorized according to participation (n=392, 15.5%) or nonparticipation (n=2131, 84.5%) in RCTs of reperfusion therapy. Primary outcome was hospital mortality. Additional outcome was time from symptom onset to receipt of reperfusion therapy. Trial participants were more likely to receive fibrinolysis with a 37 min delay in comparison with patients not included in RCTs. Time from symptom onset to reperfusion (minutes) was longer for trial participants than nonparticipants (246 ± 85 vs 233 ± 93, p=0.01). Hospital mortality was 3.61% for nonparticipants. Expected mortality (based on risk modeling) for trial participants was 2.74% (p=0.014 vs nonparticipants). Observed mortality was 1.53% (p=0.034 vs nonparticipants; p=0.16 vs expected mortality). In a multivariable analysis using logistic regression, participation in a RCT was not an independent correlate of hospital mortality (odds ratio 0.54, 95% confidence interval 0.23-2.43, p=0.16). In this consecutive cohort, despite a longer delay to reperfusion, there was no indication that participation in a RCT, starting before initiation of reperfusion therapy, was associated with a detectable increase in risk of hospital mortality among patients with STEMI. These data suggest that it is possible to consent and randomize patients with STEMI into RCTs without jeopardizing their survival. © The European Society of Cardiology 2015.

  14. The prevalence and classification of chronic kidney disease in cats randomly selected within four age groups and in cats recruited for degenerative joint disease studies

    Science.gov (United States)

    Marino, Christina L; Lascelles, B Duncan X; Vaden, Shelly L; Gruen, Margaret E; Marks, Steven L

    2015-01-01

    Chronic kidney disease (CKD) and degenerative joint disease are both considered common in older cats. Information on the co-prevalence of these two diseases is lacking. This retrospective study was designed to determine the prevalence of CKD in two cohorts of cats: cats randomly selected from four evenly distributed age groups (RS group) and cats recruited for degenerative joint disease studies (DJD group), and to evaluate the concurrence of CKD and DJD in these cohorts. The RS group was randomly selected from four age groups from 6 months to 20 years, and the DJD group comprised cats recruited to four previous DJD studies, with the DJD group excluding cats with a blood urea nitrogen and/or serum creatinine concentration >20% (the upper end of normal) for two studies and cats with CKD stages 3 and 4 for the other two studies. The prevalence of CKD in the RS and DJD groups was higher than expected at 50% and 68.8%, respectively. CKD was common in cats between 1 and 15 years of age, with a similar prevalence of CKD stages 1 and 2 across age groups in both the RS and DJD cats, respectively. We found significant concurrence between CKD and DJD in cats of all ages, indicating the need for increased screening for CKD when selecting DJD treatments. Additionally, this study offers the idea of a relationship and causal commonality between CKD and DJD owing to the striking concurrence across age groups and life stages. PMID:24217707

  15. Blood Selenium Concentration and Blood Cystatin C Concentration in a Randomly Selected Population of Healthy Children Environmentally Exposed to Lead and Cadmium.

    Science.gov (United States)

    Gać, Paweł; Pawlas, Natalia; Wylężek, Paweł; Poręba, Rafał; Poręba, Małgorzata; Pawlas, Krystyna

    2017-01-01

    This study aimed at evaluation of a relationship between blood selenium concentration (Se-B) and blood cystatin C concentration (CST) in a randomly selected population of healthy children, environmentally exposed to lead and cadmium. The studies were conducted on 172 randomly selected children (7.98 ± 0.97 years). Among participants, the subgroups were distinguished, manifesting marginally low blood selenium concentration (Se-B 40-59 μg/l), suboptimal blood selenium concentration (Se-B: 60-79 μg/l) or optimal blood selenium concentration (Se-B ≥ 80 μg/l). At the subsequent stage, analogous subgroups of participants were selected separately in groups of children with BMI below median value (BMI selenium concentration and blood cystatin C concentration. On the other hand, in children with low body mass index, a negative non-linear relationship was present between blood selenium concentration and blood cystatin C concentration.

  16. Prevalence and classification of chronic kidney disease in cats randomly selected from four age groups and in cats recruited for degenerative joint disease studies.

    Science.gov (United States)

    Marino, Christina L; Lascelles, B Duncan X; Vaden, Shelly L; Gruen, Margaret E; Marks, Steven L

    2014-06-01

    Chronic kidney disease (CKD) and degenerative joint disease are both considered common in older cats. Information on the co-prevalence of these two diseases is lacking. This retrospective study was designed to determine the prevalence of CKD in two cohorts of cats: cats randomly selected from four evenly distributed age groups (RS group) and cats recruited for degenerative joint disease studies (DJD group), and to evaluate the concurrence of CKD and DJD in these cohorts. The RS group was randomly selected from four age groups from 6 months to 20 years, and the DJD group comprised cats recruited to four previous DJD studies, with the DJD group excluding cats with a blood urea nitrogen and/or serum creatinine concentration >20% (the upper end of normal) for two studies and cats with CKD stages 3 and 4 for the other two studies. The prevalence of CKD in the RS and DJD groups was higher than expected at 50% and 68.8%, respectively. CKD was common in cats between 1 and 15 years of age, with a similar prevalence of CKD stages 1 and 2 across age groups in both the RS and DJD cats, respectively. We found significant concurrence between CKD and DJD in cats of all ages, indicating the need for increased screening for CKD when selecting DJD treatments. Additionally, this study offers the idea of a relationship and causal commonality between CKD and DJD owing to the striking concurrence across age groups and life stages. © ISFM and AAFP 2013.

  17. SNPs selected by information content outperform randomly selected microsatellite loci for delineating genetic identification and introgression in the endangered dark European honeybee (Apis mellifera mellifera).

    Science.gov (United States)

    Muñoz, Irene; Henriques, Dora; Jara, Laura; Johnston, J Spencer; Chávez-Galarza, Julio; De La Rúa, Pilar; Pinto, M Alice

    2017-07-01

    The honeybee (Apis mellifera) has been threatened by multiple factors including pests and pathogens, pesticides and loss of locally adapted gene complexes due to replacement and introgression. In western Europe, the genetic integrity of the native A. m. mellifera (M-lineage) is endangered due to trading and intensive queen breeding with commercial subspecies of eastern European ancestry (C-lineage). Effective conservation actions require reliable molecular tools to identify pure-bred A. m. mellifera colonies. Microsatellites have been preferred for identification of A. m. mellifera stocks across conservation centres. However, owing to high throughput, easy transferability between laboratories and low genotyping error, SNPs promise to become popular. Here, we compared the resolving power of a widely utilized microsatellite set to detect structure and introgression with that of different sets that combine a variable number of SNPs selected for their information content and genomic proximity to the microsatellite loci. Contrary to every SNP data set, microsatellites did not discriminate between the two lineages in the PCA space. Mean introgression proportions were identical across the two marker types, although at the individual level, microsatellites' performance was relatively poor at the upper range of Q-values, a result reflected by their lower precision. Our results suggest that SNPs are more accurate and powerful than microsatellites for identification of A. m. mellifera colonies, especially when they are selected by information content. © 2016 John Wiley & Sons Ltd.

  18. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial

    OpenAIRE

    Liao LY; Chen KM; Chung WS; Chien JY

    2015-01-01

    Lin-Yu Liao,1,2 Kuei-Min Chen,2 Wei-Sheng Chung,3 Jung-Yien Chien4 1Department of Nursing, Chest Hospital, Ministry of Health and Welfare, Rende District, Tainan, 2College of Nursing, Kaohsiung Medical University, Sanmin District, Kaohsiung, 3Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, 4Department of Medicine, Chest Hospital, Ministry of Health and Welfare, Rende District, Tainan, Taiwan Clinical trials identifier: NCT02329873 Background: Ac...

  19. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial

    National Research Council Canada - National Science Library

    Liao, Lin-Yu; Chen, Kuei-Min; Chung, Wei-Sheng; Chien, Jung-Yien

    2015-01-01

    .... To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD...

  20. Unplanned Hospital Visits - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Unplanned Hospital Visits – provider data. This data set includes provider data for the hospital return days (or excess days in acute care) measures, the unplanned...

  1. Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies.

    Science.gov (United States)

    Bonnes, Judith L; Brouwer, Marc A; Navarese, Eliano P; Verhaert, Dominique V M; Verheugt, Freek W A; Smeets, Joep L R M; de Boer, Menko-Jan

    2016-03-01

    Mechanical chest compression devices have been developed to facilitate continuous delivery of high-quality cardiopulmonary resuscitation (CPR). Despite promising hemodynamic data, evidence on clinical outcomes remains inconclusive. With the completion of 3 randomized controlled trials, we conduct a meta-analysis on the effect of in-field mechanical versus manual CPR on clinical outcomes after out-of-hospital cardiac arrest. With a systematic search (PubMed, Web of Science, EMBASE, and the Cochrane Libraries), we identified all eligible studies (randomized controlled trials and nonrandomized studies) that compared a CPR strategy including an automated mechanical chest compression device with a strategy of manual CPR only. Outcome variables were survival to hospital admission, survival to discharge, and favorable neurologic outcome. Twenty studies (n=21,363) were analyzed: 5 randomized controlled trials and 15 nonrandomized studies, pooled separately. For survival to admission, the pooled estimate of the randomized controlled trials did not indicate a difference (odds ratio 0.94; 95% confidence interval 0.84 to 1.05; P=.24) between mechanical and manual CPR. In contrast, meta-analysis of nonrandomized studies demonstrated a benefit in favor of mechanical CPR (odds ratio 1.42; 95% confidence interval 1.21 to 1.67; PCPR guidelines (2000 versus 2005) and the CPR strategy (P=.27). Survival to discharge and neurologic outcome did not differ between strategies. Although there are lower-quality, observational data that suggest that mechanical CPR used at the rescuer's discretion could improve survival to hospital admission, the cumulative high-quality randomized evidence does not support a routine strategy of mechanical CPR to improve survival or neurologic outcome. These findings are irrespective of the endorsed CPR guidelines during the study periods. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  2. Comparison the Effects of Shallow and Deep Endotracheal Tube Suctioning on Respiratory Rate, Arterial Blood Oxygen Saturation and Number of Suctioning in Patients Hospitalized in the Intensive Care Unit: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Mohammad Abbasinia

    2014-09-01

    Full Text Available Introduction: Endotracheal tube suctioning is essential for improve oxygenation in the patients undergoing mechanical ventilation. There are two types of shallow and deep endotracheal tube suctioning. This study aimed to evaluate the effect of shallow and deep suctioning methods on respiratory rate (RR, arterial blood oxygen saturation (SpO2 and number of suctioning in patients hospitalized in the intensive care units of Al-Zahra Hospital, Isfahan, Iran. Methods: In this randomized controlled trial, 74 patients who hospitalized in the intensive care units of Isfahan Al-Zahra Hospital were randomly allocated to the shallow and deep suctioning groups. RR and SpO2 were measured immediately before, immediately after, 1 and 3 minute after each suctioning. Number of suctioning was also noted in each groups. Data were analyzed using repeated measures analysis of variance (RMANOVA, chi-square and independent t-tests. Results: RR was significantly increased and SpO2 was significantly decreased after each suctioning in the both groups. However, these changes were not significant between the two groups. The numbers of suctioning was significantly higher in the shallow suctioning group than in the deep suctioning group. Conclusion: Shallow and deep suctioning had a similar effect on RR and SpO2. However, shallow suctioning caused further manipulation of patient’s trachea than deep suctioning method. Therefore, it seems that deep endotracheal tube suctioning method can be used to clean the airway with lesser manipulation of the trachea.

  3. Impact of adding hand-washing and water disinfection promotion to oral cholera vaccination on diarrhoea-associated hospitalization in Dhaka, Bangladesh: evidence from a cluster randomized control trial.

    Science.gov (United States)

    Najnin, Nusrat; Leder, Karin; Qadri, Firdausi; Forbes, Andrew; Unicomb, Leanne; Winch, Peter J; Ram, Pavani K; Leontsini, Elli; Nizame, Fosiul A; Arman, Shaila; Begum, Farzana; Biswas, Shwapon K; Clemens, John D; Ali, Mohammad; Cravioto, Alejandro; Luby, Stephen P

    2017-09-02

    Information on the impact of hygiene interventions on severe outcomes is limited. As a pre-specified secondary outcome of a cluster-randomized controlled trial among >400 000 low-income residents in Dhaka, Bangladesh, we examined the impact of cholera vaccination plus a behaviour change intervention on diarrhoea-associated hospitalization. Ninety neighbourhood clusters were randomly allocated into three areas: cholera-vaccine-only; vaccine-plus-behaviour-change (promotion of hand-washing with soap plus drinking water chlorination); and control. Study follow-up continued for 2 years after intervention began. We calculated cluster-adjusted diarrhoea-associated hospitalization rates using data we collected from nearby hospitals, and 6-monthly census data of all trial households. A total of 429 995 people contributed 500 700 person-years of data (average follow-up 1.13 years).Vaccine coverage was 58% at the start of analysis but continued to drop due to population migration. In the vaccine-plus-behaviour-change area, water plus soap was present at 45% of hand-washing stations; 4% of households had detectable chlorine in stored drinking water. Hospitalization rates were similar across the study areas [events/1000 person-years, 95% confidence interval (CI), cholera-vaccine-only: 9.4 (95% CI: 8.3-10.6); vaccine-plus-behaviour-change: 9.6 (95% CI: 8.3-11.1); control: 9.7 (95% CI: 8.3-11.6)]. Cholera cases accounted for 7% of total number of diarrhoea-associated hospitalizations. Neither cholera vaccination alone nor cholera vaccination combined with behaviour-change intervention efforts measurably reduced diarrhoea-associated hospitalization in this highly mobile population, during a time when cholera accounted for a small fraction of diarrhoea episodes. Affordable community-level interventions that prevent infection from multiple pathogens by reliably separating faeces from the environment, food and water, with minimal behavioural demands on impoverished communities

  4. Coping-Infused Dialogue through Patient-Preferred Live Music: A Medical Music Therapy Protocol and Randomized Pilot Study for Hospitalized Organ Transplant Patients.

    Science.gov (United States)

    Hogan, Tyler James; Silverman, Michael J

    2015-01-01

    Solid organ transplant patients often experience a variety of psychosocial stressors that can lead to distress and may hinder successful recovery. Using coping-infused dialogue (CID) through patient- preferred live music (PPLM) music therapy sessions may improve mood and decrease pain while also imparting psychoeducational knowledge concerning the identification of local and global problems and coping skills. The purpose of this pilot study was to develop a coping-based medical music therapy protocol that combines coping-infused dialogue (CID) with patient-preferred live music (PPLM) and measure the effects of the resulting CID-PPLM protocol on mood (positive and negative affect) and pain in hospitalized transplant patients. Our study used a pre-/posttest single-session wait-list control design. Participants (N=25) were randomly assigned to experimental (CID-PPLM) or control (usual care) conditions. Participants in the CID-PPLM condition received a single 30-minute session that integrated stressor identification and knowledge of coping skills (CID) with patient-preferred live music (PPLM). Results indicated no between-group differences at pretest and significant correlations between pre- and posttest measures. Concerning posttest ANCOVA analyses, there were significant between-group differences in positive affect, negative affect, and pain, with experimental participants having more favorable posttest scores than control participants. Effect sizes were in the medium-to-large range for positive affect (η2=.198), negative affect (η2=.422), and pain (η2=.303). CID through receptive PPLM may be an effective protocol for improving mood and decreasing pain in organ transplant recipients. MT interventions can be an important tool to develop rapport and enhance outcomes with patients. As greater engagement during interventions may have stronger treatment effects, we recommend future research examining patient engagement as a potential mediator of intervention effects

  5. The PRESLO study: evaluation of a global secondary low back pain prevention program for health care personnel in a hospital setting. Multicenter, randomized intervention trial

    Directory of Open Access Journals (Sweden)

    Denis Angélique

    2012-11-01

    Full Text Available Abstract Background Common low back pain represents a major public health problem in terms of its direct cost to health care and its socio-economic repercussions. Ten percent of individuals who suffer from low back pain evolve toward a chronic case and as such are responsible for 75 to 80% of the direct cost of low back pain. It is therefore imperative to highlight the predictive factors of low back pain chronification in order to lighten the economic burden of low back pain-related invalidity. Despite being particularly affected by low back pain, Hospices Civils de Lyon (HCL personnel have never been offered a specific, tailor-made treatment plan. The PRESLO study (with PRESLO referring to Secondary Low Back Pain Prevention, or in French, PREvention Secondaire de la LOmbalgie, proposed by HCL occupational health services and the Centre Médico-Chirurgical et de Réadaptation des Massues – Croix Rouge Française, is a randomized trial that aims to evaluate the feasibility and efficiency of a global secondary low back pain prevention program for the low back pain sufferers among HCL hospital personnel, a population at risk for recurrence and chronification. This program, which is based on the concept of physical retraining, employs a multidisciplinary approach uniting physical activity, cognitive education about low back pain and lumbopelvic morphotype analysis. No study targeting populations at risk for low back pain chronification has as yet evaluated the efficiency of lighter secondary prevention programs. Methods/Design This study is a two-arm parallel randomized controlled trial proposed to all low back pain sufferers among HCL workers, included between October 2008 and July 2011 and followed over two years. The personnel following their usual treatment (control group and those following the global prevention program in addition to their usual treatment (intervention group are compared in terms of low back pain recurrence and the

  6. A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial)--design, intervention, and population

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Brønnum-Hansen, Henrik

    2005-01-01

    randomized clinical trial to clarify whether hospital-based comprehensive CR is superior to usual care for patients with congestive heart failure, ischemic heart disease, or high risk for ischemic heart disease. A combined primary outcome measure included total mortality, myocardial infarction...... management, and clinical assessment. STUDY POPULATION: Of 5060 discharged patients, 1614 (32%) were eligible for the trial and 770 patients were randomized (47% of those eligible). Participants were younger (P ... that a large-scale, centrally randomized clinical trial on comprehensive CR can be conducted among a broadly defined patient group, but reaching the stipulated number of 1800 patients was difficult. Although the study included relatively many women and older people, elderly patients and patients with high...

  7. Acute changes of hip joint range of motion using selected clinical stretching procedures: A randomized crossover study.

    Science.gov (United States)

    Hammer, Adam M; Hammer, Roger L; Lomond, Karen V; O'Connor, Paul

    2017-09-01

    Hip adductor flexibility and strength is an important component of athletic performance and many activities of daily living. Little research has been done on the acute effects of a single session of stretching on hip abduction range of motion (ROM). The aim of this study was to compare 3 clinical stretching procedures against passive static stretching and control on ROM and peak isometric maximal voluntary contraction (MVC). Using a randomized crossover study design, a total of 40 participants (20 male and 20 female) who had reduced hip adductor muscle length attended a familiarization session and 5 testing sessions on non-consecutive days. Following the warm-up and pre-intervention measures of ROM and MVC, participants were randomly assigned 1 of 3 clinical stretching procedures (modified lunge, multidirectional, and joint mobilization) or a static stretch or control condition. Post-intervention measures of ROM and MVC were taken immediately following completion of the assigned condition. An ANOVA using a repeated measure design with the change score was conducted. All interventions resulted in small but statistically significant (p stretching was greater than control (p = 0.031). These data suggest that a single session of stretching has only a minimal effect on acute changes of hip abduction ROM. Although hip abduction is a frontal plane motion, to effectively increase the extensibility of the structures that limit abduction, integrating multi-planar stretches may be indicated. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Selepressin, a novel selective vasopressin V1A agonist, is an effective substitute for norepinephrine in a phase IIa randomized, placebo-controlled trial in septic shock patients

    DEFF Research Database (Denmark)

    Russell, James A; Vincent, Jean-Louis; Kjølbye, Anne Louise

    2017-01-01

    BACKGROUND: Vasopressin is widely used for vasopressor support in septic shock patients, but experimental evidence suggests that selective V1A agonists are superior. The initial pharmacodynamic effects, pharmacokinetics, and safety of selepressin, a novel V1A-selective vasopressin analogue......, was examined in a phase IIa trial in septic shock patients. METHODS: This was a randomized, double-blind, placebo-controlled multicenter trial in 53 patients in early septic shock (aged ≥18 years, fluid resuscitation, requiring vasopressor support) who received selepressin 1.25 ng/kg/minute (n = 10), 2.5 ng...... for selepressin 2.5 ng/kg/minute and placebo. Two patients were infused at 3.75 ng/kg/minute, one of whom had the study drug infusion discontinued for possible safety reasons, with subsequent discontinuation of this dose group. CONCLUSIONS: In septic shock patients, selepressin 2.5 ng/kg/minute was able...

  9. Early routine versus late selective surfactant in preterm neonates with respiratory distress syndrome on nasal continuous positive airway pressure: a randomized controlled trial.

    Science.gov (United States)

    Kandraju, Hemasree; Murki, Srinivas; Subramanian, Sreeram; Gaddam, Pramod; Deorari, Ashok; Kumar, Praveen

    2013-01-01

    Preterm neonates with respiratory distress syndrome (RDS) benefit from early application of nasal continuous positive airway pressure (nCPAP). However, it is not clear whether surfactant should be administered early as a routine to all such infants or later in a selective manner. It was the aim of this study to compare the efficacy of early routine versus late selective surfactant treatment in reducing the need for mechanical ventilation (MV) during the first week of life among moderate-sized preterm infants with RDS being supported by nCPAP. Infants born at 28(0/7) to 33(6/7) weeks of gestation with RDS and on nCPAP were randomly assigned within the first 2 h of life to early routine surfactant administration by the InSurE technique (early surfactant group) or to late selective administration of surfactant (late surfactant group). The primary outcome was need for MV in the first 7 days of life. Among 153 infants randomized to early (n = 74) or late surfactant (n = 79) groups, the need for MV was significantly lower in the early surfactant group (16.2 vs. 31.6%; relative risk 0.41, 95% confidence interval 0.19-0.91). The incidence of pneumothorax (1.9 vs. 2.3%) and the need for supplemental O2 at 28 days (2.7 vs. 8.9%) were similar in the two groups. Early routine surfactant administration within 2 h of life as compared to late selective administration significantly reduced the need for MV in the first week of life among preterm infants with RDS on nCPAP. Copyright © 2012 S. Karger AG, Basel.

  10. Does Multimodal Analgesia with Acetaminophen, Nonsteroidal Antiinflammatory Drugs, or Selective Cyclooxygenase-2 Inhibitors and Patient-controlled Analgesia Morphine Offer Advantages over Morphine Alone?: Meta-analyses of Randomized Trials

    National Research Council Canada - National Science Library

    Elia, Nadia; Lysakowski, Christopher; Tramèr, Martin R

    2005-01-01

    The authors analyzed data from 52 randomized placebo-controlled trials (4,893 adults) testing acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors given in conjunction with morphine after surgery...

  11. "Open mesh" or "strictly selected population" recruitment? The experience of the randomized controlled MeMeMe trial

    Directory of Open Access Journals (Sweden)

    Cortellini M

    2017-07-01

    Full Text Available Mauro Cortellini, Franco Berrino, Patrizia Pasanisi Department of Preventive & Predictive Medicine, Foundation IRCCS National Cancer Institute of Milan, Milan, Italy Abstract: Among randomized controlled trials (RCTs, trials for primary prevention require large samples and long follow-up to obtain a high-quality outcome; therefore the recruitment process and the drop-out rates largely dictate the adequacy of the results. We are conducting a Phase III trial on persons with metabolic syndrome to test the hypothesis that comprehensive lifestyle changes and/or metformin treatment prevents age-related chronic diseases (the MeMeMe trial, EudraCT number: 2012-005427-32, also registered on ClinicalTrials.gov [NCT02960711]. Here, we briefly analyze and discuss the reasons which may lead to participants dropping out from trials. In our experience, participants may back out of a trial for different reasons. Drug-induced side effects are certainly the most compelling reason. But what are the other reasons, relating to the participants’ perception of the progress of the trial which led them to withdraw after randomization? What about the time-dependent drop-out rate in primary prevention trials? The primary outcome of this analysis is the point of drop-out from trial, defined as the time from the randomization date to the withdrawal date. Survival functions were non-parametrically estimated using the product-limit estimator. The curves were statistically compared using the log-rank test (P=0.64, not significant. Researchers involved in primary prevention RCTs seem to have to deal with the paradox of the proverbial “short blanket syndrome”. Recruiting only highly motivated candidates might be useful for the smooth progress of the trial but it may lead to a very low enrollment rate. On the other hand, what about enrolling all the eligible subjects without considering their motivation? This might boost the enrollment rate, but it can lead to biased

  12. Assessing the Effectiveness of Empiric Aantibiotic Treatments: The Use of an Antibiogram Based Methodology in the Case of Selected Public Hospitals in Lesotho

    Directory of Open Access Journals (Sweden)

    Matthias Kofi Besa Adorka

    2015-10-01

    Full Text Available Background: Antibiotics prescribed in the presumptuous treatment of infections may be ineffective if causative pathogens acquire resistance to prescribed antibiotics. In the absence of patient follow ups for treatment outcome assessments, healthcare providers may be unaware of the effectiveness of antibiotic treatments they provide. In the empiric treatment of infections particularly, such situations may compromise appropriate selection of antibiotics. The study aimed at assessing the effectiveness of antibiotics prescribed in the empiric treatment of infections using a methodology based on information derived from antibiograms.Method: Culture sensitivity test results and relevant data on antibiotic treatment among inpatients from  selected  hospitals  were  used  to  construct  an  antibiogram  and  also determine  pathogen associations with infections and antibiotics most frequently prescribed in their empiric treatment. Parameters describing levels of antibiotic activities against pathogens associated with given infections were defined and used to evaluate the effectiveness of prescribed antibiotics. Clinical validity of results was assessed by comparing results of a simultaneous treatment outcome evaluation of antibiotic treatments of selected infections carried out.Results: The methodology was used to successfully evaluate the effectiveness of commonly prescribed antibiotics. Ampicillin and co-trimoxazole, two of the antibiotics most prescribed in the empiric treatment of infections, were predicted to be grossly ineffective in treating staphylococcal and Gram-negative bacilli (GNB infections for which they were observed to be prescribed.Conclusion: Polymicrobial causes of infections attributable mainly to gram-positive cocci and gram-negative  bacilli  were  established  as  an  etiological  feature  of  most  infections.  Multiple antibiotic treatments were shown, in effect, to be more effective than single use of the

  13. H-DROP: an SVM based helical domain linker predictor trained with features optimized by combining random forest and stepwise selection.

    Science.gov (United States)

    Ebina, Teppei; Suzuki, Ryosuke; Tsuji, Ryotaro; Kuroda, Yutaka

    2014-08-01

    Domain linker prediction is attracting much interest as it can help identifying novel domains suitable for high throughput proteomics analysis. Here, we report H-DROP, an SVM-based Helical Domain linker pRediction using OPtimal features. H-DROP is, to the best of our knowledge, the first predictor for specifically and effectively identifying helical linkers. This was made possible first because a large training dataset became available from IS-Dom, and second because we selected a small number of optimal features from a huge number of potential ones. The training helical linker dataset, which included 261 helical linkers, was constructed by detecting helical residues at the boundary regions of two independent structural domains listed in our previously reported IS-Dom dataset. 45 optimal feature candidates were selected from 3,000 features by random forest, which were further reduced to 26 optimal features by stepwise selection. The prediction sensitivity and precision of H-DROP were 35.2 and 38.8%, respectively. These values were over 10.7% higher than those of control methods including our previously developed DROP, which is a coil linker predictor, and PPRODO, which is trained with un-differentiated domain boundary sequences. Overall, these results indicated that helical linkers can be predicted from sequence information alone by using a strictly curated training data set for helical linkers and carefully selected set of optimal features. H-DROP is available at http://domserv.lab.tuat.ac.jp.

  14. A selective neurokinin-1 receptor antagonist in chronic PTSD: a randomized, double-blind, placebo-controlled, proof-of-concept trial.

    Science.gov (United States)

    Mathew, Sanjay J; Vythilingam, Meena; Murrough, James W; Zarate, Carlos A; Feder, Adriana; Luckenbaugh, David A; Kinkead, Becky; Parides, Michael K; Trist, David G; Bani, Massimo S; Bettica, Paolo U; Ratti, Emiliangelo M; Charney, Dennis S

    2011-03-01

    The substance P-neurokinin-1 receptor (SP-NK(1)R) system has been extensively studied in experimental models of stress, fear, and reward. Elevated cerebrospinal fluid (CSF) SP levels were reported previously in combat-related PTSD. No medication specifically targeting this system has been tested in PTSD. This proof-of-concept randomized, double-blind, placebo-controlled trial evaluated the selective NK(1)R antagonist GR205171 in predominately civilian PTSD. Following a 2-week placebo lead-in, 39 outpatients with chronic PTSD and a Clinician-Administered PTSD Scale (CAPS) score ≥50 were randomized to a fixed dose of GR205171 (N=20) or placebo (N=19) for 8weeks. The primary endpoint was mean change from baseline to endpoint in the total CAPS score. Response rate (≥50% reduction in baseline CAPS) and safety/tolerability were secondary endpoints. CSF SP concentrations were measured in a subgroup of patients prior to randomization. There was significant improvement in the mean CAPS total score across all patients over time, but no significant difference was found between GR205171 and placebo. Likewise, there was no significant effect of drug on the proportion of responders [40% GR205171 versus 21% placebo (p=0.30)]. An exploratory analysis showed that GR205171 treatment was associated with significant improvement compared to placebo on the CAPS hyperarousal symptom cluster. GR205171 was well-tolerated, with no discontinuations due to adverse events. CSF SP concentrations were positively correlated with baseline CAPS severity. The selective NK(1)R antagonist GR205171 had fewer adverse effects but was not significantly superior to placebo in the short-term treatment of chronic PTSD. (ClinicalTrials.gov Identifier: NCT 00211861, NCT 00383786). Published by Elsevier B.V.

  15. Determinants of pre-eclampsia/Eclampsia among women attending delivery Services in Selected Public Hospitals of Addis Ababa, Ethiopia: a case control study.

    Science.gov (United States)

    Grum, Teklit; Seifu, Abiy; Abay, Mebrahtu; Angesom, Teklit; Tsegay, Lidiya

    2017-09-15

    Pre-eclampsia is a pregnancy-specific hypertensive disorder usually occurs after 20 weeks of gestation. It is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. In Ethiopia, the major direct obstetric complications including pre-eclampsia/eclampsia account for 85% of the maternal deaths. Unlike deaths due to other direct causes, pre-eclampsia/ eclampsia related deaths appear to be increasing and linked to multiple factors, making prevention of the disease a continuous challenge. The aim of this study is to assess determinants of pre-eclampsia/eclampsiaamong women attending delivery services in selected public hospitals in Addis Ababa, Ethiopia. Hospital based unmatched case control study design was employed. The study wasconducted in Addis Ababa among women attending delivery services in two public hospitals from December, 2015 G.C. to February, 2016 G.C. with sample size of 291 (97 cases and 194 controls). Women with pre-eclampsia/eclampsia were cases and women who had not diagnosed for pre-eclampsia/eclampsia were controls. Case-control incidence density sampling followed by interviewer administered was conducted using pretested questionnaire. The data was entered in Epi Info 7 software and exported to STATA 14 for cleaning and analysis. Descriptive statistics were used todisplay the data using tables compared between cases and controls. To compare categorical variables between cases and controls Chi-squared testwas used. Both bivariable and multivariable logistic regression analyses were computed to identify the determinants of pre-eclampsia/eclampsia. Factors that were found to have statistically significant association with pre-eclampsia or eclampsia were primigravida (AOR: 2.68, 95% CI: 1.38, 5.22), history of preeclampsia on prior pregnancy (AOR: 4.28, 95% CI: 1.61, 11.43), multiple pregnancy (AOR: 8.22, 95% CI: 2.97, 22.78), receiving nutritional counseling during pregnancy (AOR: 0.22, 95% CI: 0.1, 0.48) and drinking

  16. Age-related Cataract in a Randomized Trial of Selenium and Vitamin E in Men: The SELECT Eye Endpoints (SEE) Study

    Science.gov (United States)

    Christen, William G.; Glynn, Robert J.; Gaziano, J. Michael; Darke, Amy K.; Crowley, John J.; Goodman, Phyllis J.; Lippman, Scott M.; Lad, Thomas E.; Bearden, James D.; Goodman, Gary E.; Minasian, Lori M.; Thompson, Ian M.; Blanke, Charles D.; Klein, Eric A.

    2014-01-01

    Importance Observational studies suggest a role for dietary nutrients such as vitamin E and selenium in cataract prevention. However, the results of randomized trials of vitamin E supplements and cataract have been disappointing, and are not yet available for selenium. Objective To test whether long-term supplementation with selenium and vitamin E affects the incidence of cataract in a large cohort of men. Design, Setting, and Participants The SELECT Eye Endpoints (SEE) study was an ancillary study of the SWOG-coordinated Selenium and Vitamin E Cancer Prevention Trial (SELECT), a randomized, placebo-controlled, four arm trial of selenium and vitamin E conducted among 35,533 men aged 50 years and older for African Americans and 55 and older for all other men, at 427 participating sites in the US, Canada, and Puerto Rico. A total of 11,267 SELECT participants from 128 SELECT sites participated in the SEE ancillary study. Intervention Individual supplements of selenium (200 µg/d from L-selenomethionine) and vitamin E (400 IU/d of all rac-α-tocopheryl acetate). Main Outcome Measures Incident cataract, defined as a lens opacity, age-related in origin, responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-report confirmed by medical record review, and cataract extraction, defined as the surgical removal of an incident cataract. Results During a mean (SD) of 5.6 (1.2) years of treatment and follow-up, 389 cases of cataract were documented. There were 185 cataracts in the selenium group and 204 in the no selenium group (hazard ratio [HR], 0.91; 95 percent confidence interval [CI], 0.75 to 1.11; P=.37). For vitamin E, there were 197 cases in the treated group and 192 in the placebo group (HR, 1.02; CI, 0.84 to 1.25; P=.81). Similar results were observed for cataract extraction. Conclusions and Relevance These randomized trial data from a large cohort of apparently healthy men indicate that long-term daily supplementation with selenium

  17. Complementary and Alternative Medicine Use among Physicians in Oriental Medicine Hospitals in Vietnam: A Hospital-Based Survey

    OpenAIRE

    Duong Duc Pham; Jong Hyang Yoo; Binh Quoc Tran; Thuy Thu Ta

    2013-01-01

    Interest in complementary and alternative medicine (CAM) is growing worldwide, even in Vietnam where traditional medicine is considered mainstream. We conducted a survey of the knowledge, attitudes, and practices of CAM therapies among physicians in oriental medicine (OM) hospitals in Vietnam. A two-stage random selection process selected 337 physicians who were interviewed using a face-to-face method with a standardized structured questionnaire. Data from 312 physicians who completed the que...

  18. Food pantry selection solutions: a randomized controlled trial in client-choice food pantries to nudge clients to targeted foods.

    Science.gov (United States)

    Wilson, Norbert L W; Just, David R; Swigert, Jeffery; Wansink, Brian

    2017-06-01

    Food pantries and food banks are interested in cost-effective methods to encourage the selection of targeted foods without restricting choices. Thus, this study evaluates the effectiveness of nudges toward targeted foods. In October/November 2014, we manipulated the display of a targeted product in a New York State food pantry. We evaluated the binary choice of the targeted good when we placed it in the front or the back of the category line (placement order) and when we presented the product in its original box or unboxed (packaging). The average uptake proportion for the back treatment was 0.231, 95% CI = 0.179, 0.29, n = 205, and for the front treatment, the proportion was 0.337, 95% CI = 0.272, 0.406, n = 238 with an odds ratio of 1.688, 95% CI = 1.088, 2.523. The average uptake for the unboxed treatment was 0.224, 95% CI = 0.174, 0.280, n = 255, and for the boxed intervention, the proportion was 0.356, 95% CI = 0.288, 0.429, n = 188 with an odds ratio of 1.923, 95% CI = 1.237, 2.991. Nudges increased uptake of the targeted food. The findings also hold when we control for a potential confounder. Low cost and unobtrusive nudges can be effective tools for food pantry organizers to encourage the selection of targeted foods. NCT02403882.

  19. The definition, selection and implementation of a new Clinical Information System to prepare the hospital for the electronic future: an example of project-based education

    NARCIS (Netherlands)

    Spil, Antonius A.M.; van de Meeberg, Henk J.; Sikkel, Nicolaas

    The software supplier of a large hospital has been taken over. The hospital gets notice that the central hospital information system (HIS) will no longer be maintained, starting next year. This problem, not uncommon in business today, is used as a real-life case in a project-based course for first

  20. EcmPred: Prediction of extracellular matrix proteins based on random forest with maximum relevance minimum redundancy feature selection

    KAUST Repository

    Kandaswamy, Krishna Kumar Umar

    2013-01-01

    The extracellular matrix (ECM) is a major component of tissues of multicellular organisms. It consists of secreted macromolecules, mainly polysaccharides and glycoproteins. Malfunctions of ECM proteins lead to severe disorders such as marfan syndrome, osteogenesis imperfecta, numerous chondrodysplasias, and skin diseases. In this work, we report a random forest approach, EcmPred, for the prediction of ECM proteins from protein sequences. EcmPred was trained on a dataset containing 300 ECM and 300 non-ECM and tested on a dataset containing 145 ECM and 4187 non-ECM proteins. EcmPred achieved 83% accuracy on the training and 77% on the test dataset. EcmPred predicted 15 out of 20 experimentally verified ECM proteins. By scanning the entire human proteome, we predicted novel ECM proteins validated with gene ontology and InterPro. The dataset and standalone version of the EcmPred software is available at http://www.inb.uni-luebeck.de/tools-demos/Extracellular_matrix_proteins/EcmPred. © 2012 Elsevier Ltd.

  1. Randomized Controlled Trial of Acupuncture for Women with Fibromyalgia: Group Acupuncture with Traditional Chinese Medicine Diagnosis-Based Point Selection.

    Science.gov (United States)

    Mist, Scott D; Jones, Kim Dupree

    2018-02-13

    Group acupuncture is a growing and cost-effective method for delivering acupuncture in the United States and is the practice model in China. However, group acupuncture has not been tested in a research setting. To test the treatment effect of group acupuncture vs group education in persons with fibromyalgia. Random allocation two-group study with repeated measures. Group clinic in an academic health center in Portland, Oregon. Women with confirmed diagnosis of fibromyalgia (American College of Radiology 1990 criteria) and moderate to severe pain levels. Twenty treatments of a manualized acupuncture treatment based on Traditional Chinese Medicine diagnosis or group education over 10 weeks (both 900 minutes total). Weekly Revised Fibromyalgia Impact Questionnaire (FIQR) and Global Fatigue Index at baseline, five weeks, and 10 weeks and a four-week follow-up were assessed. Thirty women were recruited, with 78% reporting symptoms for longer than 10 years. The mean attendance was 810 minutes for acupuncture and 861 minutes for education. FIQR total, FIQR pain, and Global Fatigue Index all had clinically and statistically significant improvement in the group receiving acupuncture at end of treatment and four weeks post-treatment but not in participants receiving group education between groups. Compared with education, group acupuncture improved global symptom impact, pain, and fatigue. Furthermore, it was a safe and well-tolerated treatment option, improving a broader proportion of patients than current pharmaceutical options.

  2. Randomized trial of switching from prescribed non-selective non-steroidal anti-inflammatory drugs to prescribed celecoxib

    DEFF Research Database (Denmark)

    Macdonald, Thomas M; Hawkey, Chris J; Ford, Ian

    2017-01-01

    infarction or other biomarker positive acute coronary syndrome, non-fatal stroke or CV death analysed using a Cox model with a pre-specified non-inferiority limit of 1.4 for the hazard ratio (HR). RESULTS: In total, 7297 participants were randomized. During a median 3-year follow-up, fewer subjects than......-years with celecoxib and 1.10 per 100 patient-years with nsNSAIDs (HR = 1.04; 95% confidence interval, 0.81-1.33; P = 0.75). Pre-specified non-inferiority was achieved in the ITT analysis. The upper bound of the 95% confidence limit for the absolute increase in OT risk associated with celecoxib treatment was two......NSAIDs. There was no advantage of a strategy of switching prescribed nsNSAIDs to prescribed celecoxib. This study excluded an increased risk of the primary endpoint of more than two events per 1000 patient-years associated with switching to prescribed celecoxib....

  3. [Lung volume reduction surgery (LVRS): criteria for selecting patient in Antonio Pedro Hospital, Federal Fluminense University, Niter i city, Rio de Janeiro, Brazil].

    Science.gov (United States)

    Behrsin, Rodolfo Fred; da Silva Junior, Cyro Teixeira; Gabetto, José Manoel; Lima, Oriane de Almeida Santana

    2003-01-01

    Chronic Obstructive Pulmonary Disease (CPOD) is an important problem in Brazil and other countries. The clinical treatment of ambulatory patients is now reasonably standardized. Lung volume reduction surgery (LVRS) is an alternative of surgical treatment of emphysema (aside from lung transplantation). The aim of this study was to analyse patient selection criteria for LVRS. This study was carried out using a sample of 31 patients referred to and given assistance to at the Smoking and Chronic Obstructive Pulmonary Disease Outpatient Ward Antonio Pedro Hospital, who were evaluated to check whether or not they could be eligible for LVRS. Aiming at evaluating the major criteria for eligibility for LVRS, the patients underwent a protocol including standardized anamnesis and physical examination, spirometry with maximum inspiratory and expiratory flow volume curves associated with post-bronchodilatator test, room air arterial blood gases, a six-minute walking test, plain chest roentgenograms and left lateral chest roentgenograms, high-resolution chest computed tomographic scans and lung perfusion scans. Statistical analysis was conducted with description of data proportions. Contraindications to surgery included chronic bronchitis (29% or nine patients), forced expiratory volume in one second (FEV 1) more than 80 percent predicted (13% or four patients), negative consent for surgery (10% or three patients), fibrosis pattern, severe depression and bronchiectasis (two patients each one), solitary pulmonary nodule, severe obesity, severe bullous emphysema, pulmonary hipertension, pulmonary resection history, current cigarette smoking, diffuse emphysema with alpha-1-antitrypsin deficiency and severe cardiac disease (one patient each). Indication. One selected patient with severe symptoms of emphysema met criteria for LVRS (bilateral superior lobe heterogeneous pattern of emphysema on chest computed tomography and lung perfusion scan). Chronic bronchitis was the major

  4. Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015.

    Science.gov (United States)

    Hagaman, Ashley K; Khadka, S; Lohani, S; Kohrt, B

    2017-12-01

    Yearly, 600,000 people complete suicide in low- and middle-income countries, accounting for 75% of the world's burden of suicide mortality. The highest regional rates are in South and East Asia. Nepal has one of the highest suicide rates in the world; however, few investigations exploring patterns surrounding both male and female suicides exist. This study used psychological autopsies to identify common factors, precipitating events, and warning signs in a diverse sample. Randomly sampled from 302 police case reports over 24 months, psychological autopsies were conducted for 39 completed suicide cases in one urban and one rural region of Nepal. In the total police sample (n = 302), 57.0% of deaths were male. Over 40% of deaths were 25 years or younger, including 65% of rural and 50.8% of female suicide deaths. We estimate the crude urban and rural suicide rates to be 16.1 and 22.8 per 100,000, respectively. Within our psychological autopsy sample, 38.5% met criteria for depression and only 23.1% informants believed that the deceased had thoughts of self-harm or suicide before death. Important warning signs include recent geographic migration, alcohol abuse, and family history of suicide. Suicide prevention strategies in Nepal should account for the lack of awareness about suicide risk among family members and early age of suicide completion, especially in rural and female populations. Given the low rates of ideation disclosure to friends and family, educating the general public about other signs of suicide may help prevention efforts in Nepal.

  5. Recruitment strategies should not be randomly selected: empirically improving recruitment success and diversity in developmental psychology research

    Science.gov (United States)

    Sugden, Nicole A.; Moulson, Margaret C.

    2015-01-01

    Psychological and developmental research have been critiqued for the lack of diversity of research samples. Because differences in culture, race, and ethnicity can influence participant behavior, limited diversity limits the generalizability of the findings. These differences may also impact how participants behave in response to recruitment attempts, which suggests that recruitment itself may be leveraged to increase sample diversity. The goal of the current study was to determine what factors, within a recruitment interaction, could be leveraged to increase success and diversity when recruiting families with children for developmental research. Study 1 found three factors influenced success: (1) recruitment was more successful when other potential participants were also interested (i.e., recruiters were busy), (2) recruiters of particular races were more successful than recruiters of other races, and (3) differences in success were related to what the recruiter said to engage the potential participant (i.e., the script). The latter two factors interacted, suggesting some recruiters were using less optimal scripts. To improve success rates, study 2 randomly assigned scripts to recruiters and encouraged them to recruit more vigorously during busy periods. Study 2 found that two factors influenced success: (1) some scripts were more successful than others and (2) we were more successful at recruiting non-White potential participants than White participants. These two interacted, with some scripts being more successful with White and other scripts being more successful with non-White families. This intervention significantly increased recruitment success rate by 8.1% and the overall number of families recruited by 15.3%. These findings reveal that empirically evaluating and tailoring recruitment efforts based on the most successful strategies is effective in boosting diversity through increased participation of children from non-White families. PMID:25972829

  6. Recruitment strategies should not be randomly selected: empirically improving recruitment success and diversity in developmental psychology research.

    Science.gov (United States)

    Sugden, Nicole A; Moulson, Margaret C

    2015-01-01

    Psychological and developmental research have been critiqued for the lack of diversity of research samples. Because differences in culture, race, and ethnicity can influence participant behavior, limited diversity limits the generalizability of the findings. These differences may also impact how participants behave in response to recruitment attempts, which suggests that recruitment itself may be leveraged to increase sample diversity. The goal of the current study was to determine what factors, within a recruitment interaction, could be leveraged to increase success and diversity when recruiting families with children for developmental research. Study 1 found three factors influenced success: (1) recruitment was more successful when other potential participants were also interested (i.e., recruiters were busy), (2) recruiters of particular races were more successful than recruiters of other races, and (3) differences in success were related to what the recruiter said to engage the potential participant (i.e., the script). The latter two factors interacted, suggesting some recruiters were using less optimal scripts. To improve success rates, study 2 randomly assigned scripts to recruiters and encouraged them to recruit more vigorously during busy periods. Study 2 found that two factors influenced success: (1) some scripts were more successful than others and (2) we were more successful at recruiting non-White potential participants than White participants. These two interacted, with some scripts being more successful with White and other scripts being more successful with non-White families. This intervention significantly increased recruitment success rate by 8.1% and the overall number of families recruited by 15.3%. These findings reveal that empirically evaluating and tailoring recruitment efforts based on the most successful strategies is effective in boosting diversity through increased participation of children from non-White families.

  7. Recruitment strategies shouldn’t be randomly selected: Empirically improving recruitment success and diversity in developmental psychology research

    Directory of Open Access Journals (Sweden)

    Nicole Andrea Sugden

    2015-04-01

    Full Text Available Psychological and developmental research have been critiqued for the lack of diversity of research samples. Because differences in culture, race, and ethnicity can influence participant behavior, limited diversity limits the generalizability of the findings. These differences may also impact how participants behave in response to recruitment attempts, which suggests that recruitment itself may be leveraged to increase sample diversity. The goal of the current study was to determine what factors, within a recruitment interaction, could be leveraged to increase success and diversity when recruiting families with children for developmental research. Study 1 found three factors influenced success: 1 recruitment was more successful when other potential participants were also interested (i.e., recruiters were busy, 2 recruiters of particular races were more successful than recruiters of other races, and 3 differences in success were related to what the recruiter said to engage the potential participant (i.e., the script. The latter two factors interacted, suggesting some recruiters were using less optimal scripts. To improve success rates, study 2 randomly assigned scripts to recruiters and encouraged them to recruit more vigorously during busy periods. Study 2 found that two factors influenced success: 1 some scripts were more successful than others and 2 we were more successful at recruiting non-White potential participants than White participants. These two interacted, with some scripts being more successful with White and other scripts being more successful with non-White families. This intervention significantly increased recruitment success rate by 8.1% and the overall number of families recruited by 15.3%. These findings reveal that empirically evaluating and tailoring recruitment efforts based on the most successful strategies is effective in boosting diversity through increased participation of children from non-White families.

  8. Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study

    Science.gov (United States)

    2012-01-01

    Background Single embryo transfer (SET) remains underutilized as a strategy to reduce multiple gestation risk in IVF, and its overall lower pregnancy rate underscores the need for improved techniques to select one embryo for fresh transfer. This study explored use of comprehensive chromosomal screening by array CGH (aCGH) to provide this advantage and improve pregnancy rate from SET. Methods First-time IVF patients with a good prognosis (age IVF program to select single blastocysts for fresh SET in good prognosis patients. The observed aneuploidy rate (44.9%) among biopsied blastocysts highlights the inherent imprecision of SET when conventional morphology is used alone. Embryos randomized to the aCGH group implanted with greater efficiency, resulted in clinical pregnancy more often, and yielded a lower miscarriage rate than those selected without aCGH. Additional studies are needed to verify our pilot data and confirm a role for on-site, rapid aCGH for IVF patients contemplating fresh SET. PMID:22551456

  9. Evaluation of nursing care associated with infants born to mothers with drugs abuse and its comparison with the standards in selected hospitals in Kerman 2013-2014.

    Science.gov (United States)

    Mahdavi Khaki, Z; AbbasZadeh, A; Rassoli, M; Zayeri, F

    2015-01-01

    Background. Pregnancy of women addicted to drugs is a public health problem in most countries, leading to various problems in the mother, the fetus, and the newborn. Since these babies are at risk of various complications and even death, competent and appropriate care of these children is needed. The present study aimed to assess the quality of nursing care provided to newborns and its comparison with the existing standards in infants and neonatal intensive care units of the selected Hospitals in Kerman. Materials and Methods. In this descriptive conducted study, 400 nursing cares, provided to infants born to mothers with drugs abuse, observed and were compared to standard checklists provided by the latest resources and the world's scientific papers. The checklist provided was based on the evaluation of infants and included two distinct categories: non-drug therapy and drug treatment. Finally, the data were analyzed. Results. The consistency quality of the nursing cares provided to infants born to mothers with drugs abuse was evaluated with the existing standards in children, 73% receiving non-drug therapy and 81% of the infants receiving drug treatment. Conclusion. Compared to standards in the normal state, nursing care was associated with babies born to mothers with drugs abuse. The reduction in the incidence of morbidity and mortality in this group of infants was expected in the case of familiarity and training of nursing and the use of caring standards, particularly when applying non-drug therapy.

  10. Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies

    NARCIS (Netherlands)

    Bonnes, J.L.; Brouwer, M.A.; Navarese, E.P.; Verhaert, D.V.; Verheugt, F.W.; Smeets, J.L.; Boer, M.J. de

    2016-01-01

    STUDY OBJECTIVE: Mechanical chest compression devices have been developed to facilitate continuous delivery of high-quality cardiopulmonary resuscitation (CPR). Despite promising hemodynamic data, evidence on clinical outcomes remains inconclusive. With the completion of 3 randomized controlled

  11. Implementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial

    NARCIS (Netherlands)

    Vlemmix, F.; Rosman, A.N.; Rijnders, M.E.; Beuckens, A.; Opmeer, B.C.; Mol, B.W.J.; Kok, M.; Fleuren, M.A.H.

    2015-01-01

    Onjective: To determine the effectiveness of a client or care-provider strategy to improve the implementation of external cephalic version. Design: Cluster randomized controlled trial.Setting: Twenty-five clusters; hospitals and their referring midwifery practices randomly selected in the

  12. Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

    Directory of Open Access Journals (Sweden)

    Tania Cristina Morais Santa Barbara Rehem

    2013-09-01

    Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

  13. Quality of life and standard of living in a randomly selected group of psychiatrically disabled people in Sweden 2 years after a psychiatry reform.

    Science.gov (United States)

    Carlsson, I; Frederiksen, S-O; Gottfries, C-G

    2002-07-01

    In Sweden, a psychiatry reform, aimed at improving the living conditions of the psychiatrically disabled, came into force in 1995. The aim of the present study was to evaluate the impact of the reform by investigating quality of life and standard of living 2 years later in a randomly selected group of people with longstanding psychiatric disability. Self-ratings and interviews were conducted in a study group and a control group. The study group consisted of 19 women and 18 men (mean age 46.1 years) diagnosed with neurosis, schizophrenia or affective disorder. The control group consisted of 19 women and 17 men (mean age 48.7 years). Self-rated quality of life was significantly poorer in the study group (P standard of living in either group but a significant negative correlation in the control group (P standard of living.

  14. Comparing Patients’ Opinions on the Hospital Discharge Process Collected With a Self-Reported Questionnaire Completed Via the Internet or Through a Telephone Survey: An Ancillary Study of the SENTIPAT Randomized Controlled Trial

    Science.gov (United States)

    Carrat, Fabrice; Hejblum, Gilles

    2015-01-01

    Background Hospital discharge, a critical stage in the hospital-to-home transition of patient care, is a complex process with potential dysfunctions having an impact on patients’ health on their return home. No study has yet reported the feasibility and usefulness of an information system that would directly collect and transmit, via the Internet, volunteer patients’ opinions on their satisfaction concerning the organization of hospital discharge. Objective Our primary objective was to compare patients’ opinions on the discharge process collected with 2 different methods: self-questionnaire completed on a dedicated website versus a telephone interview. The secondary goal was to estimate patient satisfaction. Methods We created a questionnaire to examine hospital discharge according to 3 dimensions: discharge logistics organization, preplanned posthospital continuity-of-care organization, and patients’ impressions at the time of discharge. A satisfaction score (between 0 and 1) for each of those dimensions and an associated total score were calculated. Taking advantage of the randomized SENTIPAT trial that questioned patients recruited at hospital discharge about the evolution of their health after returning home and randomly assigned them to complete a self-questionnaire directly online or during a telephone interview, we conducted an ancillary study comparing satisfaction with the organization of hospital discharge for these 2 patient groups. The questionnaire was proposed to 1141 patients included in the trial who were hospitalized for ≥2 days, among whom 867 eligible patients had access to the Internet at home and were randomized to the Internet or telephone group. Results Of the 1141 patients included, 755 (66.17%) completed the questionnaire. The response rates for the Internet (39.1%, 168/430) and telephone groups (87.2%, 381/437) differed significantly (Pdischarge logistics organization, P=.12 for preplanned posthospital continuity

  15. Effect of a Counseling Session Bolstered by Text Messaging on Self-Selected Health Behaviors in College Students: A Preliminary Randomized Controlled Trial.

    Science.gov (United States)

    Sandrick, Janice; Tracy, Doreen; Eliasson, Arn; Roth, Ashley; Bartel, Jeffrey; Simko, Melanie; Bowman, Tracy; Harouse-Bell, Karen; Kashani, Mariam; Vernalis, Marina

    2017-05-17

    The college experience is often the first time when young adults live independently and make their own lifestyle choices. These choices affect dietary behaviors, exercise habits, techniques to deal with stress, and decisions on sleep time, all of which direct the trajectory of future health. There is a need for effective strategies that will encourage healthy lifestyle choices in young adults attending college. This preliminary randomized controlled trial tested the effect of coaching and text messages (short message service, SMS) on self-selected health behaviors in the domains of diet, exercise, stress, and sleep. A second analysis measured the ripple effect of the intervention on health behaviors not specifically selected as a goal by participants. Full-time students aged 18-30 years were recruited by word of mouth and campuswide advertisements (flyers, posters, mailings, university website) at a small university in western Pennsylvania from January to May 2015. Exclusions included pregnancy, eating disorders, chronic medical diagnoses, and prescription medications other than birth control. Of 60 participants, 30 were randomized to receive a single face-to-face meeting with a health coach to review results of behavioral questionnaires and to set a health behavior goal for the 8-week study period. The face-to-face meeting was followed by SMS text messages designed to encourage achievement of the behavioral goal. A total of 30 control subjects underwent the same health and behavioral assessments at intake and program end but did not receive coaching or SMS text messages. The texting app showed that 87.31% (2187/2505) of messages were viewed by intervention participants. Furthermore, 28 of the 30 intervention participants and all 30 control participants provided outcome data. Among intervention participants, 22 of 30 (73%) showed improvement in health behavior goal attainment, with the whole group (n=30) showing a mean improvement of 88% (95% CI 39-136). Mean

  16. The effects of Nordic Walking training on selected upper-body muscle groups in female-office workers: A randomized trial.

    Science.gov (United States)

    Kocur, Piotr; Pospieszna, Barbara; Choszczewski, Daniel; Michalowski, Lukasz; Wiernicka, Marzena; Lewandowski, Jacek

    2017-01-01

    Regular Nordic Walking training could improve fitness and reduce tenderness in selected muscle groups in office workers. An assessment of the effects of a 12-week Nordic Walking training program on the perceived pain threshold (PPT) and the flexibility of selected upper-body muscle groups in postmenopausal female office workers. 39 office workers were selected at random for the treatment group (NWg, n = 20) and the control group (Cg, n = 19). The persons from the NW group completed a 12-week Nordic Walking training program (3 times a week/1 hour). PPTs measurements in selected muscles and functional tests evaluating upper-body flexibility (Back Scratch - BS) were carried out twice in every participant of the study: before and after the training program. A significant increase in PPT (kg/cm2) was observed in the following muscles in the NW group only: upper trapezius (from 1,32 kg/cm2 to 1,99 kg/cm2), mid trapezius (from 2,92 kg/cm2 to 3,30 kg/cm2), latissimus dorsi (from 1,66 kg/cm2 to 2,21 kg/cm2) and infraspinatus (from 1,63 kg/cm2 to 2,93 kg/cm2). Moreover, a significant improvement in the BS test was noted in the NW group compared with the control group (from -1,16±5,7 cm to 2,18±5,1 cm in the NW group vs from -2,52±6,1 to -2,92±6,2 in the control group). A 12-week Nordic Walking training routine improves shoulder mobility and reduces tenderness in the following muscles: trapezius pars descendens and middle trapezius, infraspinatus and latissimus dorsi, in female office workers.

  17. Zeta Sperm Selection Improves Pregnancy Rate and Alters Sex Ratio in Male Factor Infertility Patients: A Double-Blind, Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Nasr Esfahani Mohammad Hossein

    2016-07-01

    Full Text Available Background Selection of sperm for intra-cytoplasmic sperm injection (ICSI is usually considered as the ultimate technique to alleviate male-factor infertility. In routine ICSI, selection is based on morphology and viability which does not necessarily preclude the chance injection of DNA-damaged or apoptotic sperm into the oocyte. Sperm with high negative surface electrical charge, named “Zeta potential”, are mature and more likely to have intact chromatin. In addition, X-bearing spermatozoa carry more negative charge. Therefore, we aimed to compare the clinical outcomes of Zeta procedure with routine sperm selection in infertile men candidate for ICSI. Materials and Methods From a total of 203 ICSI cycles studied, 101 cycles were allocated to density gradient centrifugation (DGC/Zeta group and the remaining 102 were included in the DGC group in this prospective study. Clinical outcomes were com- pared between the two groups. The ratios of Xand Y bearing sperm were assessed by fluorescence in situ hybridization (FISH and quantitative polymerase chain reaction (qPCR methods in 17 independent semen samples. Results In the present double-blind randomized clinical trial, a significant increase in top quality embryos and pregnancy rate were observed in DGC/Zeta group compared to DGC group. Moreover, sex ratio (XY/XX at birth significantly was lower in the DGC/Zeta group compared to DGC group despite similar ratio of X/Y bearings sper- matozoa following Zeta selection. Conclusion Zeta method not only improves the percentage of top embryo quality and pregnancy outcome but also alters the sex ratio compared to the conventional DGC method, despite no significant change in the ratio of Xand Ybearing sperm population (Registration number: IRCT201108047223N1.

  18. Transition to phacoemulsification at the farabi eye hospital, iran.

    Science.gov (United States)

    Hashemi, Hassan; Mohammadi, S-Farzad; Mazouri, Arash; Majdi-N, Mercede; Jabbarvand, Mahmoud; Z-Mehrjardi, Hadi

    2011-04-01

    To provide objective evidence on the transition of cataract surgical care at Farabi Eye Hospital, Iran. Two separate years, 2003 and 2006, were selected for evaluation. One thousand nine hundred fifty-seven surgical records of age-related cataract cases were randomly selected and reviewed. Three hundred fifty-three patients (405 eyes) in 2006 and 125 patients (153 eyes) in 2003 were selected randomly for a follow-up examination. The two phases were compared in terms of surgical routines, patient characteristics and outcomes for statistical differences. P Farabi Eye Hospital in the mid-2000s. This was accompanied by significant expansion of the spectrum of cataract surgery candidates and remarkable attainment of surgical skill.

  19. A comparison of the effects of random and selective mass extinctions on erosion of evolutionary history in communities of digital organisms.

    Directory of Open Access Journals (Sweden)

    Gabriel Yedid

    Full Text Available The effect of mass extinctions on phylogenetic diversity and branching history of clades remains poorly understood in paleobiology. We examined the phylogenies of communities of digital organisms undergoing open-ended evolution as we subjected them to instantaneous "pulse" extinctions, choosing survivors at random, and to prolonged "press" extinctions involving a period of low resource availability. We measured age of the phylogenetic root and tree stemminess, and evaluated how branching history of the phylogenetic trees was affected by the extinction treatments. We found that strong random (pulse and strong selective extinction (press both left clear long-term signatures in root age distribution and tree stemminess, and eroded deep branching history to a greater degree than did weak extinction and control treatments. The widely-used Pybus-Harvey gamma statistic showed a clear short-term response to extinction and recovery, but differences between treatments diminished over time and did not show a long-term signature. The characteristics of post-extinction phylogenies were often affected as much by the recovery interval as by the extinction episode itself.

  20. A theory for the origin of a self-replicating chemical system. I - Natural selection of the autogen from short, random oligomers

    Science.gov (United States)

    White, D. H.

    1980-01-01

    A general theory is presented for the origin of a self-replicating chemical system, termed an autogen, which is capable of both crude replication and translation (protein synthesis). The theory requires the availability of free energy and monomers to the system, a significant background low-yield synthesis of kinetically stable oligopeptides and oligonucleotides, the localization of the oligomers, crude oligonucleotide selectivity of amino acids during oligopeptide synthesis, crude oligonucleotide replication, and two short peptide families which catalyze replication and translation, to produce a localized group of at least one copy each of two protogenes and two protoenzymes. The model posits a process of random oligomerization, followed by the random nucleation of functional components and the rapid autocatalytic growth of the functioning autogen to macroscopic amounts, to account for the origin of the first self-replicating system. Such a process contains steps of such high probability and short time periods that it is suggested that the emergence of an autogen in a laboratory experiment of reasonable time scale may be possible.

  1. Effects of Video Game Training on Measures of Selective Attention and Working Memory in Older Adults: Results from a Randomized Controlled Trial

    Science.gov (United States)

    Ballesteros, Soledad; Mayas, Julia; Prieto, Antonio; Ruiz-Marquez, Eloísa; Toril, Pilar; Reales, José M.

    2017-01-01

    Video game training with older adults potentially enhances aspects of cognition that decline with aging and could therefore offer a promising training approach. Although, previous published studies suggest that training can produce transfer, many of them have certain shortcomings. This randomized controlled trial (RCT; Clinicaltrials.gov ID: NCT02796508) tried to overcome some of these limitations by incorporating an active control group and the assessment of motivation and expectations. Seventy-five older volunteers were randomly assigned to the experimental group trained for 16 sessions with non-action video games from Lumosity, a commercial platform (http://www.lumosity.com/) or to an active control group trained for the same number of sessions with simulation strategy games. The final sample included 55 older adults (30 in the experimental group and 25 in the active control group). Participants were tested individually before and after training to assess working memory (WM) and selective attention and also reported their perceived improvement, motivation and engagement. The results showed improved performance across the training sessions. The main results were: (1) the experimental group did not show greater improvements in measures of selective attention and working memory than the active control group (the opposite occurred in the oddball task); (2) a marginal training effect was observed for the N-back task, but not for the Stroop task while both groups improved in the Corsi Blocks task. Based on these results, one can conclude that training with non-action games provide modest benefits for untrained tasks. The effect is not specific for that kind of training as a similar effect was observed for strategy video games. Groups did not differ in motivation, engagement or expectations. PMID:29163136

  2. Effects of Video Game Training on Measures of Selective Attention and Working Memory in Older Adults: Results from a Randomized Controlled Trial.

    Science.gov (United States)

    Ballesteros, Soledad; Mayas, Julia; Prieto, Antonio; Ruiz-Marquez, Eloísa; Toril, Pilar; Reales, José M

    2017-01-01

    Video game training with older adults potentially enhances aspects of cognition that decline with aging and could therefore offer a promising training approach. Although, previous published studies suggest that training can produ