1,486 research outputs found
Spotlight on eluxadoline for the treatment of patients with irritable bowel syndrome with diarrhea
No full textKonstantinos C Fragkos Gastrointestinal Services, University College London Hospitals, London, UK Background: Irritable bowel syndrome with diarrhea (IBS-D) has limited options for treatment currently, including mainly anti-motility medications, antispasmodics, and antidepressants. This review discusses the properties of a new drug, eluxadoline, a gut-targeting mu- and kappa-opioid receptor agonist and a delta-opioid receptor antagonist, and its efficacy and safety in patients with IBS-D. Materials and methods: A systematic review of the literature was undertaken to identify studies that had investigated eluxadoline as a treatment in IBS-D. A narrative review of other information is provided with respect to pharmacological and chemical properties. Where suitable, meta-analysis was performed with a random-effects model to produce a pooled estimate. Results: Eluxadoline showed efficacy improving stool consistency (standardized mean difference [SMD]: -0.29 at 12 weeks, p = 0.0004; -0.46 at 26 weeks, p = 0.0001), global symptoms (SMD: -0.15 at 12 weeks, p = 0.006; -0.14 at 26 weeks, p = 0.02), quality of life (SMD: 0.21 at 12 weeks, p < 0.0001; 0.16 at 26 weeks, p = 0.007), pain (SMD: -0.17 at 12 weeks, p = 0.001; -0.16 at 26 weeks, p = 0.01), and adequate relief (odds ratio [OR]: 1.99 at 12 weeks, p < 0.00001; 1.78 at 26 weeks, p < 0.0001). It also improved IBS severity and other abdominal symptoms such as bloating, discomfort, and risk of urgency and fecal incontinence. Its main side effects included constipation (OR: 3.49, p < 0.00001), vomiting (OR: 3.42, p = 0.0002), abdominal pain (OR: 1.78, p = 0.007), and nausea (OR: 1.42, p = 0.07). The overall quality of trials was satisfactory with the meta-analyses providing largely homogeneous outcomes. Conclusion: Eluxadoline’s place in clinical practice might prove useful since the pharmacological options of IBS-D are limited and eluxadoline showed a positive effect in treating the symptoms of IBS-D. Keywords: eluxadoline, irritable bowel syndrome, diarrhea, stool consistency, pai
Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016) Fragkos KC, Sotiropoulos I, Frangos CC. Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016). World J Meta-Anal 2019; 7(1): 1-30 [DOI: 10.13105/wjma.v7.i1.1]
No full textBACKGROUND:
Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation.
AIM:
To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency.
METHODS:
A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach’s alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I2 statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger’s test, Begg’s test, and the trim and fill analysis.
RESULTS:
Thirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The overall reliability was 0.805 (95%CI 0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries of the studies under investigation and student types but most heterogeneity remained unexplained.
CONCLUSION:
The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales
Plantar keratoderma of Sézary syndrome
No full textSézary syndrome is an extremely rare form of cutaneous T-cell lymphoma. It presents suddenly and is associated with a poor prognosis. Clinical recognition is crucial for the diagnostic process and initiation of appropriate treatment. Plantar keratoderma is usually pathognomonic for Sézary syndrome and clinicians should be alerted to its presence
Exploring whether (and how) self-reflection can improve practice as a teacher educator
No full textThe present essay describes a model under which a method of self-improvement of teacher-educator practice can be implemented by analyzing personal practices. I will focus my argument on investigating self-reflection and the subject under investigation will be the educator: how can they self-reflect in order to enhance their learning and hence their practice. The first step of the model is self-reflection. The second step will be self-study. The final step will be self-research techniques (such as autoethnography). This final step will provide the validity for improving personal practice in a possibly reliable way such that practices of narcissism and self-replicating redundancies or errors are avoided. By acknowledging the multiple identities a teacher assumes in their professional practice allows them to analyze them systematically and eventually improve on them
Mekanisme Restrukturisasi Dalam Penyelesaian Pembiayaan Murabahah Bermasalah Pada Bank Sumut Syariah KC Medan Katamso
No full textThe purpose of this study is to understand the restructuring mechanism in solving problematic murabahah financing at Bank Sumut Syariah KC Medan Katamso. This research uses descriptive qualitative method. The source of the data obtained and used in this study was obtained directly at the research location at PT Bank Sumut Syariah KC Medan Katamso. This study uses primary data. In addition, in this study, raw data was also collected in the form of secondary data, such as evidence, documents or historical reports, documents, archives, whether published or not. The data collection that the writer did was through observation, interviews and document studies. Observations were made through direct observation at PT Bank Sumut Syariah KC Medan Katamso. Interviews were addressed directly to the Business or Marketing division of PT. Bank Sumut Syariah KC Medan Katamso according to the information needs by answering the questions raised by the author. Document research conducted by the author is in the form of written data or other documents needed by the author. After doing the research, it can be concluded that the North Sumatra Sharia KC Medan Katamso Bank in implementing the restructuring mechanism there are principles that must be followed in resolving problem financing contained in Bank Indonesia Regulations and can be said to be good. The principles applied by Bank Sumut Syariah KC Medan Katamso are in accordance with Bank Indonesia Regulation No. 13/9/PBI/2011 concerning amendments to Bank Indonesia Regulation Number 10/1/PBI/2008 concerning Financing Restructuring for Sharia Banks and UUS. Namely, rescheduling, reconditioning, and restructuring
The Effectiveness of Teaching Clinical Empathy to Medical Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
No full textPurpose: Clinical empathy is a necessary trait to provide effective patient care, despite differences in how it is defined and constructed. The aim of this study was to examine whether empathy interventions in medical students are effective and how confounding factors potentially moderate this effect.
Method: The authors performed a systematic review and meta-analysis. They searched the literature published between 1948 and 2018 for randomized controlled trials that examined empathy interventions in medical students. The search (database searching, citation tracking, hand-searching relevant journals) yielded 380 studies, which they culled to 16 that met the inclusion criteria. For the meta-analysis, they used a random effects model to produce a pooled estimate of the standardized mean difference (SMD), then completed subgroup analyses.
Results: The authors found evidence of the possibility of response and reporting bias. The pooled SMD was 0.68 (95% confidence interval 0.43, 0.93), indicating a moderately positive effect of students developing empathy after an intervention compared with those in the control groups. There was no evidence of publication bias, but heterogeneity was significantly high (I2 = 88.5%, P < .01). Subgroup analyses indicated that significant moderating factors for developing empathy were age, country, scope of empathy measurement, type of empathy intervention, and presence of rehearsal. Moderating factors with limited evidence were sex, study quality, journal impact factor, and intervention characteristics.
Conclusions: Despite heterogeneity and biases, empathy interventions in medical students are effective. These findings reinforce arguments in the literature and add considerable rigor from the meta-analysis. The authors propose a conceptual model for educators to follow when designing empathy interventions in medical students
PWE-101 Citrulline as a marker of intestinal function and absorption in clinical settings: a systematic review meta-analysis
No full textPelaksanaan Pembiayaan Modal Kerja Musyarakah Pada PT. Bank Syariah Indonesia KC Padang
No full textThe purpose of this research was to determine the implementation of Musyarakah working capital financing at PT. Bank Syariah Indonesia KC Padang. In analyzing the data, the author uses qualitative data analysis methods as a research method that describes descriptively the implementation of Musyarakah working capital financing at the PT. Bank Syariah Indonesia KC Padang. The results of this study there are several stages of procedures in the Implementation of Musyarakah Working Capital Financing at PT. Bank Syariah Indonesia KC Padang, namely submitting a financing application, financing feasibility analysis, the decision to grant Musyarakah working capital financing which is divided into two decisions, namely the financing decision is accepted and the decision is rejected. If the financing decision is accepted or rejected, it is submitted in writing by providing clear and thoughtful reasons. After the financing decision is approved, it will proceed to the stage of contract and disbursement of financing, supervision of financing and repayment of financing
Penyelesaian Pembiayaan Bermasalah Terhadap Perjanjian Kepemilikan Rumah Di Brk Syariah Kc Arifin Ahmad Pekanbaru
No full textABSTRACT Housing is a basic need besides food and clothing. The role of banking greatly affects the economic activities of a country. Providing housing financing is one of the most basic bank businesses, one of which is providing housing financing by BRK Syariah. Before providing financing the bank needs to assess customers who apply for financing. Because, not a few customers fail to fulfill their obligations in house payments which results in problematic financing. In resolving problematic financing, settlement is not always carried out through court channels, but also efforts to resolve problems carried out outside the court provided by BRK Syariah. The formulation of the problem in this research is how to review the law regarding the resolution of problematic home ownership financing at BRK Syariah KC Arifin Ahmad Pekanbaru and what factors cause problematic home ownership financing at BRK Syariah KC Arifin Ahmad Pekanbaru. The type of research used is included in the empirical group and the sample for this research is one part of the BRK Syariah bank KC Arifin Ahmad Pekanbaru, namely the Management Director and several customers who have been declared in default or failed to carry out their obligations. From the results of research that has been conducted by the author, that the settlement of problematic financing of home ownership in BRK Syariah KC Arifin Ahmad Pekanbaru is litigation and non-litigation, such as rescheduling, reconditioning and restructuring and there are 2 (two) factors causing the financing of problematic home ownership in BRK Syariah KC Arifin Ahmad Pekanbaru, namely internal factors originating from the bank that are not careful both from analyzing prospective customers, as well as in the calculation of home financing and ext from the bank that is not careful both from analyzing prospective customers, as well as in the calculation of rumaa financing and external factors from the customer, where there are some customers who do not make payments because there is an element of intentionality and an element of customer unintentionality. Keywords
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