Australasian Medical Journal
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The effects of aerobic exercise on cognitive performance and sleep quality haemodialysis patients
Get PDFBackgroundCognitive impairment and sleep disturbance are very common in chronic kidney disease (CKD) and are strongly associated with increased mortality among the patients. Even though, exercise is considered to be a quantifiable activity that improves cognition in animals and humans, but few studies have examined the efficacy of exercise on cognitive function and sleep quality in CKD.AimsThis study was performed to evaluate the effects of aerobic exercise during haemodialysis on the cognitive performance and sleep quality.MethodsIn this clinical trial study, 38 patients with an average age of 47 years under haemodialysis were divided into control (N=11) and experimental (N=27) groups. Patients in experimental group were participated in a 24 weeks training progressive exercise that performed during the first two hours of their haemodialysis on a stationary bicycle, three times a week, for 75 minutes each time. Cognitive performance using Mini-Mental State Examination, Symbol Digit Test and Trail Making Test–B and sleep quality with PSQI questioner were assessed before, 12 weeks and 24 weeks after training program. Statistical analysis was performed using SPSS 18, Mann-Whitney U and repeated measure analysis.ResultsAfter the exercise, there was a significant increase in the Trail Making Test–B and sleep quality during the first 12 weeks and a significant improvement after 24 weeks in Mini-Mental State Examination and Symbol Digit Test in exercise group (P < 0.05).ConclusionIt seems that aerobic exercises has a significant impact on cognitive performance and sleep quality in haemodialysis patients and can be used as part of the treatment for haemodialysis patients but further research is warranted to clarify the involved mechanisms
Pulmonary hydatidosis patterns and clinical outcomes
Get PDFBackgroundPulmonary hydatidosis remains a significant health problem in endemic areas. The clinical patterns and presentation vary according to the size, number, location and integrity of the cyst.AimsThe aim of this study is to retrospectively evaluate the pattern and outcomes of patients diagnosed with pulmonary hydatidosis treated surgically in a tertiary hospital in northern Jordan. MethodsA retrospective review of patients with pulmonary hydatidosis between December 2009 and December 2017 were performed. Data regarding demographic features, clinical presentation, serology testing, clinical outcomes and duration of medical treatment after surgery were obtained. Chest X-Ray and computerized tomography as well as liver ultrasound were the main methods of diagnosis. Parenchyma preserving excisions of the laminated membrane with capitonnage of the remaining cavity were performed in all patients. Albendazole was prescribed for 3–6 months postoperatively. ResultsEighty-eight patients were involved. Mean age was 29.5±16.7 years (range 8–75). Females comprised 52 per cent of the patients. The main presenting symptoms were cough, dyspnea and chest pain. Thirty-two (37 per cent) patients had rupture of the cyst at the time of the presentation; 15 patients had direct rupture, 10 had communicating rupture and contained rupture was diagnosed in seven patients. Multiple and/or bilateral lesions were encountered in 25/88 (28.5 per cent) and 15 (17 per cent) patients respectively. Lower lobes were involved in 73.8 per cent of the cases. The mean hospital stay was 6.53±2.83 days. Post-operative morbidities were developed in 12/88 (13 per cent) patients with air leak (5 per cent) as the most common morbidity. No recurrences or mortalities were reported in the follow up period. ConclusionParenchyma preserving cyst excision with capitonnage provides a low postoperative morbidity in patients with both intact and complicated pulmonary hydatidosis. To decrease the risk of recurrence albendazole treatment is indicated postoperatively especially for recurrent, complicated and multiple hydatid cysts
Evaluation of sensitivity and the specificity of Canadian CT head rule and New Orleans criteria in patients with head injury
Get PDFBackgroundMillions of people around the world are annually under emergency investigation due to severe head injuries. Computed tomography (CT) scans is a diagnostic procedure that can be done for most people. AimsThis study is aimed to evaluate the sensitivity and the specificity of Canadian and New Orleans criteria in determining the rate of head injury.Methods To obtain the relationship between clinical symptoms and CT scan results, the required information was obtained by filling out the records and physical examination in the emergency department and the results from the patients were statistically analysed. Data needed to complete the questionnaire was collected from patient, the patient, their concomitant examination, and the information in their medical records. The raw data from the questionnaire was analysed using SPSS version 17 software. In this study, after obtaining the CT scan results, the individuals were classified into two clinical criteria, New Orleans and Canadian, and their sensitivity and specificity were analysed using ROC curve analysis.Results ROC curve analysis data showed that the sensitivity and specificity of New Orleans criteria are 31 per cent and 69 per cent, respectively, and the sensitivity and specificity of Canadian criteria are 76 per cent and 74 per cent, respectively. Data shows that the Canadian curve has a significant difference compared to basic state (P-Value < 0.05).ConclusionDespite abnormal CT scan results in patients with head trauma, there is a significant relationship between headache and a combination of symptoms in patients. The results can be used in decision-making on involved in performing a CT scan. ROC curve analysis also showed that the Canadian criterion has higher sensitivity and specificity for the diagnosis of severe head trauma compared to New Orleans criteria
Cultural competency of nursing faculty teaching in baccalaureate nursing programs in the United States
Get PDFBackgroundNursing education has acknowledged that cultural competency should be an educational competency of baccalaureate programs. Although nursing faculty are expected to adequately prepare all nurses to provide culturally competent care for patients, the literature suggests that nurse educators’ low levels of cultural competence contributes to under-preparation of new nurses to provide culturally competent care.AimsThe study assessed nursing faculty cultural competence of teaching at a bachelor of science in nursing programs across the United States and identified demographic factors that are associated with that level.MethodsStudy used descriptive and correlational design through the use of online questionnaires. The study included (N=461) nursing faculty across the United States with a response rate of 23 per cent and included 461. Data were collected using a validated tool namely the “Cultural Diversity Questionnaire for Nurse Educators Revised”. Statistical analysis with means and standard deviation were calculated for all continuous variables. For all aims, results were summarized using regression estimates, p-values, and 95 per cent Confidence Interval (CI per cent).Results The Overall Cultural Competence (OCC) mean=166 indicated that nursing faculty has moderate level of cultural competence. The highest index was Cultural Knowledge Subscale M=43.53, and the lowest index was Cultural Encounter Subscale M=22.50. Regression analysis demonstrated that demographic variables were predictive of the mean score. Transcultural teaching behaviours subscale was considerably low related to the OCC scale, adjusting for all other variables.ConclusionThe current study identified previous cultural exposure and cultural education as crucial factors to improve cultural competence. The researchers concluded that faculty cultural training needs to be mandated and should be more inclusive not only of educational material but also to include practice exposure to a diverse population. The training should occur during orientations, practice, and as an annual competency validation
Neutrophil to lymphocyte with monocyte to lymphocyte ratio and white blood cell count in prediction of lung cancer
Get PDFBackgroundLung cancer is the most common cause of cancer deaths in both sexes, while it is very difficult for screenings and early detection. AimsThis study aims to clarify the role of systematic inflammation markers, including white blood cell (WBC), neutrophil (NEU), monocyte (MONO), platelet (PLT), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) in prediction of lung cancer. Methods A case-control study was conducted on 1,315 primary lung cancer patients and 1,315 healthy adults with matched age and gender at Cho Ray hospital. NLR, MLR and PLR were calculated by using neutrophil, lymphocyte, monocyte and platelet count which were recalled from laboratory database. With 600 cases in the derivation set, the logistic regression with univariate analysis was used to identify the impacted marker, then developing the optimal prediction model for lung cancer by logistic regression with multivariate method. The diagnostic values of optimal model consisting of sensitivity (Sen), specificity (Spe), positive predictive value (PPV), negative predictive value (NPV) and the area under the ROC curve (AUC) value were extracted and verified on all data, in validation set. Results The median values of WBC, NEU, MONO, PLT, NLR, MLR and PLR in lung cancer were not significantly difference between histological subtypes and clinical stages (p > 0.05), but higher than the values in control group (p < 0.01). Multivariates analysis shows that NLR, MLR and WBC were three parameters that have the significant impact of the optimal prediction model (p < 0.01). The AUC value, sensitivity and specificity of the optimal model for lung cancer detection were 0.881, 73.5 per cent (95 per cent CI:70.3–76.6) and 87.7 per cent (95 per centCI:85.2–89.9), respectively. Whereas, the PPV and NPV values of prediction model were 85.7 per cent (95 per cent CI:82.8–88.2) and 76.8 (95 per centCI:73.9–79.5), respectively. Among three biomarkers, the AUC values of NLR (0.853) and MLR (0.842) were higher than the value of WBC (0.752) (p < 0.01).ConclusionThe results of this study show that NLR with MLR and WBC in optimal prediction model are promising biomarkers for lung cancer screening that could be applied in clinical practice with the advantage of convenience and low cost
Acute cholecystitis managed in a rural surgical department
Get PDFObjectivesTo define the outcome over a prolonged period of an unselected cohort of patients presenting with acute cholecystitis (AC) to a 560 bed rural hospital in Israel.Design, setting and participantsRetrospective case series analysed from a single referral centre between 2006 and 2015. Separated into Group 1 managed by emergent cholecystectomy, Group 2 treated with antibiotics and delayed cholecystectomy, Group 3 treated with percutaneous cholecystostomy (PC) and selected delayed cholecystectomy and Group 4 managed entirely conservatively with no subsequent cholecystectomy.Methods Assessment of complication rates: in-hospital and delayed cause-specific morbidity and mortality along with conversion rates and the risk of intraoperative stone spillage. Results Of 321 patients hospitalized for AC, there were 50 in Group 1, 68 in Group 2, 59 in Group 3 and 98 in Group 4. Group 3 were older with more comorbidities and when coming to surgery had more open conversions. Intraoperative stone spillage was more common in Groups 2 and 3. The length of hospital stay was greater for Groups 1 and 3. Of the Group 4 cases, 63.2 per cent remained asymptomatic over a median follow-up of 78 months. Of those with recurrent biliary symptoms, 58.3 per cent were ASA Grade III/IV with 25/36 late deaths 80 per cent of which were from non-biliary causes. ConclusionIn the management of AC, early cholecystectomy is favored with non-operative approaches like PC drainage or antibiotic treatment alone being reserved for frailer comorbid cases. The absolute need for subsequent cholecystectomy is not supported by this series and requires further investigation
The staffs’ understanding of the role of the health department website on health education in a university of medical sciences
Get PDFBackgroundHealth related organizations have sought to design websites to provide various services, including access to relevant information by health care providers.AimsThe purpose of this study was to investigate the understanding of health care staff members of the role of the health sector website of Semnan University of Medical Sciences in their health education.Methods This cross –sectional study was performed on 369 employees of health care institutions affiliated to Semnan University of Medical Sciences, Iran. An anonymous self-administered questionnaire was developed.Results Mean score of the employees’ attitudes towards total characteristics of the health website were understanding of concepts of the health website was 3.65, for communications in the health website was 3.27 and for patient- centered of health website was 3.55. The results showed that there were significant relationships among total characteristics of the health website (P < 0.001).ConclusionOne can infer that the University's health department website is not proportionate to most of its domestic clients and could not provide the information needs of the healthcare staff. Therefore, practical and methodological considerations in the design of the website of the health department should be taken into consideration in order to provide user-oriented information on the website
Influence of different orthodontic brackets and chemical preparations of ceramic crowns on shear bond strength
Get PDFBackgroundBonding to ceramic restorations remains a major challenge to orthodontists, especially due to an increasing number of adults seeking orthodontic treatment.AimsThe objective of this research was to investigate the influence of two chemical methods used for surface conditioning of ceramic crowns, on shear bond strength (SBS) of metallic and ceramic orthodontic brackets bonded to ceramic surfaces.Methods The study was conducted on 48 prepared specimens of metallic and ceramic orthodontic brackets bonded to ceramic crowns, conditioned with two different etching materials: hydrofluoric acid (HFA), or phosphoric acid, and subsequently, silane. SBS was tested using Universal Testing Machine. The samples were analysed using Scanning Electron Microscope, to determine adhesive remnant index (ARI). Statistical data was processed with ANOVA, and ARI was evaluated using x2 test, with level of significance α=0.05.Results SBS values of the groups etched with HFA and silane, compared to the groups etched with phosphoric acid and silane, are not significantly increased. However, ceramic brackets show significantly higher SBS values than metallic brackets.ConclusionBoth types of ceramic surface conditioning procedures have similar features and provide strong enough SBS values to realize the orthodontic treatment. Also, the assumption that only the type of bracket significantly affects the SBS value can be accepted
Effect of alogliptin on hypertensive chronic kidney disease patients with type 2 diabetes mellitus
Get PDFBackgroundDiabetes mellitus (DM) is a leading cause of chronic kidney disease (CKD). The antihyperglycemic treatment options for patients with Type 2 DM are limited because of safety and tolerability concerns.AimsTo retrospectively assess the effect of using Alogliptin; a dipeptidyl peptidase-4 inhibitor (DPP-4i) along with conventional gliclazide: a sulphonylurea (SU) on renal outcomes and glycaemic control in T2DM patients with mild CKD and hypertension.MethodsA total of 76 patient records (38 males and 38 females) of patient ages 40–60 were analysed from the kidney unit at Punjab Care hospital, Lahore, Pakistan. All patients had a confirmed history of T2DM with mild CKD and established hypertension.Eligible patients were divided into two groups of 38 individuals each. Group SU received gliclazide monotherapy (SU) or Alogliptin (DPP-4i)+gliclazide (SU) add on therapy. All patients were followed up for 12 months.ResultsThe alogliptin (DPP-4i) plus gliclazide (SU) add on therapy group, in comparison to the group only receiving gliclazide (SU), showed a significant difference in eGFR values. The mean±SD GFR values post 12 months were 74.8±0.31 (95%CI:74.8±0.09;74.7–74.9) and 76.1±0.25 (95%CI: 76.1±0.08;76.0-76.2) for SU vs. SU+DPP-4i, respectively, with mean calculated effect size of 1.6,. HbA1c, 1,5 AG and ipid profile values have significantly changed (