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Epidemic of Mental Wellness Problems amongst Elderly Diabetic patients and also Financial risk Factors in Belgium.
During the late decade, significantly higher rates of celiac serology normalization were achieved during the first two years of follow-up. CONCLUSION In recent years, children with CD were diagnosed with milder symptoms, showed better adherence and demonstrated earlier normalization of celiac serology. BACKGROUND The recommended standard immunosuppressive therapy for renal transplant recipients comprises an initial induction therapy mainly with an interleukin-2-receptor antibody (IL2-RA) and a triple maintenance therapy. With tacrolimus and mycophenolate acid it is unknown whether IL2-RA application affects the short- and long-term results. This question is addressed in the present analysis. METHODS From July 2007 to June 2019 a total of 127 living donor kidney transplant recipients meeting the center-specific definition of immunologic low risk situation (first transplantation, HLA-mismatch ≤3, panel reactive antibody ≤10%) were identified. In 83 recipients with a first-degree relationship to the donor we omitted the IL2-RA induction (IL2-RA-). The remaining 44 recipients, mostly not first-degree relatives, served as controls (IL2-RA+). Biopsy-proven acute rejection and long-term patient and graft survival rates were compared. RESULTS Biopsy-proven acute rejection rates after 3 months were similar in both groups with 4.8% (IL2-RA-) vs 13.7% (IL2-RA+; P = .0937), including borderline rejection rates of 18.0% (IL2-RA-) vs 18.3% (IL2-RA+; P = 1.000), respectively. Ten-year long-term survival rates were comparable between the IL2-RA- and the IL2-RA+ group with 95.6% vs 93.5% (patient survival; P = .5465) and 92.1% vs 90.6% (death-censored graft survival; P = .8893). CONCLUSION For low-risk living donor kidney transplant recipients with first-degree relationship to the donor, it is safe to omit induction therapy with IL2-RA. BACKGROUND Human polyoma virus-associated nephropathy frequently refers to allograft failure after kidney transplant. Thus, the early detection of viral activation is extremely important for these immunocompromised patients. METHODS Previously, urine polyoma virus-infected cells (decoy cells) were indicated as the virus action, usually screened by the routine papanicolaou cytology in renal biopsy, but these methods are complex and the positive rate is low. In this article, the direct microscopy observation method, Wright-Giemsa staining, and Sternheimer-Malbin (SM) staining were all used to screen the decoy cells in urine samples of 213 kidney transplant patients who had used immunosuppressive drugs. RESULTS Among them, decoy cells were detected in 40 cases (18.8%) by the direct observation method, 44 cases (20.7%) by Wright-Giemsa staining and 49 cases (23.0%) by SM staining. Furthermore, the most common polyoma viruses, BK and JC viruses, were also confirmed in 41 (83.7%) cases among these 49 decoy cell-positive samples. Importantly, compared with other decoy cell detection methods, SM staining is fast, easy to operate, and has a high positive rate. CONCLUSION Therefore, SM staining is recommended as a fast and effective method for screening urine decoy cells in kidney transplant patients. BACKGROUND Although the topic of brain death (BD) has been increasing in popularity considerably in recent years by the snowballing number of patients suffering from end-organ failure and waiting for organ transplantation, the literature indicates insufficient information regarding the comparison of scientific articles focusing on BD, authors' and nations', even governments' tendency about this issue. OBJECTIVES In the present study, we aimed to make a bibliometric analysis of the articles focusing on the subject of BD, which is one of the most trendy topics in organ transplantation. MATERIAL AND METHODS The terms "brain death," were searched in Thomson Reuters, Web of Science search engine for the years between 1995 and 2019. All the articles found were subjected to bibliometric analysis. RESULTS Web of Science database included 3487 articles. The United States was found to be the most productive country in all methods, and Transplantation Proceedings was the journal that contributed most to the literature on the subject of BD. A positive correlation between publication productivity and gross domestic product/gross domestic product per capita and human development index was found (r = 0.470, P less then .05; r = 0.359, P less then .05; r = 0.603, P less then .001, respectively). Also, there was a negative correlation between the number of published articles and the population of the country (r = -0.083, P less then .001). CONCLUSION Although the top country focusing on the subject of BD was the United States in terms of bibliometrics, we found that there is a correlation between the indices measuring the welfare and development level of the country and publication productivity about BD, which means developed countries show more tendency about BD, which is the main component of the definitive treatment of end-organ failure. OBJECTIVE To evaluate the effects of the nurse-led health coaching on health-related quality of life and clinical health outcomes among frequent attenders in primary healthcare. METHODS A quasi-experimental study design. A total of 110 patients were enrolled in the study. The experimental group (n = 52) received nurse-led health coaching and the control group (n = 58) received the usual care at primary health care centres in Finland. The data were collected before the intervention and 12 months via a questionnaire of health-related quality of life and clinical health outcomes as measured by health-coaching nurses. RESULTS This study found frequent attenders have low health-related quality of life. The nurse-led health coaching showed no differences in health-related quality of life between the experimental and control groups. However, the nurse-led health coaching had statistically significant effects on the blood pressure and health-related quality of life among the experimental participants, especially in emotional role limitation and energy. CONCLUSIONS This study suggests that nurse-led health coaching may lead to an improvement in the health-related quality of life and blood pressure among frequent attenders. PRACTICE IMPLICATIONS The health-coaching sessions with own health-coaching nurses and action plans support the frequent attenders´ health promotion goals and implementation. OBJECTIVE To investigate whether parent-initiated or doctor-initiated decisions about limiting life-sustaining treatment (LST) in neonatal care has consequences for how possible courses of action are presented. METHOD Formal conversations (n = 27) between doctors and parents of critically ill babies from two level 3 neonatal intensive care units were audio or video recorded. Sequences of talk where decisions about limiting LST were presented were analysed using Conversation Analysis and coded using a Conversation Analytic informed coding framework. Relationships between codes were analysed using Fisher's exact test. RESULTS When parents initiated the decision point, doctors subsequently tended to refer to or list available options. When doctors initiated, they tended to use 'recommendations' or 'single-option' choice (conditional) formats (p=0.017) that did not include multiple treatment options. Parent initiations overwhelmingly concerned withdrawal, as opposed to withholding of LST (p=0.030). CONCLUSION Aligning parents to the trajectory of the news about their baby's poor condition may influence how the doctor subsequently presents the decision to limit LST, and thereby the extent to which parents are invited to participate in shared decision-making. PRACTICE IMPLICATIONS Explicitly proposing treatment options may provide parents with opportunities to be involved in decisions for their critically ill babies, thereby fostering shared decision-making. OBJECTIVES To assess the potential impact of using screening recommendations for bleeding disorders in patients with Noonan syndrome on perioperative bleeding complications. learn more STUDY DESIGN We performed a retrospective, single-site cohort study; patients were identified by query of the electronic medical record. All patients with a clinical diagnosis of Noonan syndrome over a 10-year period were included. Data on surgeries, hematologic evaluation, bleeding symptoms, and bleeding complications were extracted. Surgeries were graded as major or minor. RESULTS We identified 101 patients with Noonan syndrome, 70 of whom required surgery for a total of 164 procedures. Nine patients (9/70; 12.8%) had bleeding complications, occurring in those without comprehensive testing or perioperative intervention and undergoing major or dental surgery. Based on these findings, the risk of a bleeding complication for patients with Noonan syndrome who did not have comprehensive testing or perioperative intervention was 6.2% (95% CI 2.3%-10.1%), indicating the number needed to treat or screen would be 16 to prevent 1 bleeding complication (95% CI 9.9-43.9). The majority of patients had either no or incomplete evaluation (59 of 101; 58.4%). CONCLUSIONS With proper evaluation and management, the bleeding risk in patients with Noonan syndrome can be minimized. link2 Efforts are needed to address the knowledge and implementation gap in this evaluation. A hepatobiliary iminodiacetic acid (HIDA) scan is frequently used in an attempt to exclude biliary atresia in infants who are cholestatic. We present 6 cases of confirmed biliary atresia in infants who had biliary patency reported on HIDA scan. We demonstrate that misinterpreted HIDA scans led to delayed diagnosis and surgical intervention for biliary atresia. OBJECTIVE To determine the frequency that non-first-line antibiotics, safety-net antibiotic prescriptions (SNAPS), and longer than recommended durations of antibiotics were prescribed for children ≥2 years of age with acute otitis media and examine patient and system level factors that contributed to these outcomes. STUDY DESIGN Children age ≥2 years with acute otitis media seen at Denver Health Medical Center outpatient locations from January to December 2018 were included. The percentages of patients who received first-line antibiotics, SNAPs, and recommended durations of antibiotics were determined. Factors associated with non-first-line and longer than recommended antibiotic durations were evaluated using multivariate logistic regression modeling. RESULTS Of the 1025 visits evaluated, 98.0% were prescribed an antibiotic; only 4.5% of antibiotics were SNAPs. link3 Non-first-line antibiotics were prescribed to 18.8% of patients. Most antibiotic durations (94.1%) were longer than the institution recommended 5 days and 54.3% were ≥10 days. Private insurance was associated with non-first-line antibiotics (aOR, 1.89; 95% CI, 1; 14-3.14, P = .01). Patients who were younger (2-5 years; aOR 2.01; 95% CI, 1.32-3.05; P less then .001) or seen in emergency/urgent care sites (aOR, 1.73; 95% CI, 1.26-2.38; P less then .001) were more likely to receive ≥10 days of antibiotic compared with those in pediatric clinics. CONCLUSIONS Antibiotic stewardship interventions that emphasize the duration of antibiotic therapy as well as the use of SNAPs or observation may be higher yield than those focusing on first-line therapy alone. Numerous system and patient level factors are associated with off-guideline prescribing.
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