Murphysanford6357
Tapentadol is a combined opioid agonist and norepinephrine reuptake inhibitor with fewer gastrointestinal side effects at equianalgesic doses compared with classical strong opioids. Previous studies on tapentadol have included multi-morbid patients in whom confounders exclude detailed assessment of the mechanistic effects and strict comparison with other opioids or placebo. This study aimed at investigating the effects of tapentadol and oxycodone on gastrointestinal motility and gastrointestinal side effects.
21 healthy males participated in a randomized, double-blind, placebo-controlled, crossover study. Tapentadol (50mg twice daily), oxycodone (10mg twice daily), or placebo tablets were administered for 14days. Segmental gastrointestinal transit times and colonic motility parameters were measured with electromagnetic capsules. Gastrointestinal side effects were assessed using questionnaires.
During dosing with tapentadol, gastrointestinal side effects and motility parameters were on placebo level. Compared with tapentadol, oxycodone increased whole gut transit time by 17.9 hours (p=.015) and rectosigmoid transit time by 6.5 hours (p=.005). Compared with tapentadol, oxycodone also reduced long, fast antegrade colonic movements (p=.001). In comparison with placebo, oxycodone prolonged whole gut transit time by 31.6 hours, (p<.001). Moreover, less long, fast antegrade colonic movements (p=.002) were observed during oxycodone. For oxycodone only, slow colonic movements were associated with gastrointestinal side effects.
In this mechanistic study, tapentadol caused significantly less colonic dysmotility and gastrointestinal side effects as compared with oxycodone in equianalgesic doses.
In this mechanistic study, tapentadol caused significantly less colonic dysmotility and gastrointestinal side effects as compared with oxycodone in equianalgesic doses.
To describe the birth prevalence and characteristics of congenital heart defects in a geographically defined Australian population.
This descriptive, population-based study examined congenital heart defects in live births, stillbirths and pregnancy terminations ascertained by the Western Australian Register of Developmental Anomalies, 1990-2016. BTK inhibitor research buy Birth prevalence (per 1000 births) was stratified by severity, known cause, maternal and birth characteristics, and primary diagnosis; and prevalence ratios were calculated for Aboriginal versus non-Aboriginal births. Temporal trends in prevalence, diagnosis age and infant mortality were examined.
For births 1990-2010 (allowing 6 years for complete case ascertainment by 2016), 6419 cases were identified; prevalence was 11.5 per 1000 births (95% confidence interval (CI), 11.2-11.8). Severe defects were ascertained in 2.5 per 1000 births (95% CI 2.4-2.7). Most cases were liveborn (5842, 91.0%), and 28.9% had other birth defects. Prevalence was slightly higher in Aboriginal births (prevalence ratio 1.1; 95% CI 1.0-1.2); and the infant mortality rate more than doubled (13.4% vs. 5.8%, P< 0.001). Prenatal diagnosis increased over time but, in remote areas, was significantly lower for Aboriginal versus non-Aboriginal cases (3.1% vs. 9.3%; P= 0.008). A cause was identified in 920 cases (14.3%), more often for severe defects (347, 24.4%); 63% of known causes were rare diseases. Congenital heart defects associated with fetal alcohol spectrum disorder were much more common in Aboriginal births (prevalence ratio 82; 95% CI 28-239).
Earlier detection of congenital heart defects and improved survival has occurred over time, although discrepancies between ethnic groups and regions warrant further investigation and strategic action.
Earlier detection of congenital heart defects and improved survival has occurred over time, although discrepancies between ethnic groups and regions warrant further investigation and strategic action.
Biofeedback therapy is useful for treatment of fecal incontinence (FI), but is not widely available and labor intensive. We investigated if home biofeedback therapy (HBT) is non-inferior to office biofeedback therapy (OBT).
Patients with FI (≥1 episode/week) were randomized to HBT or OBT for 6weeks. HBT was performed daily using novel device that provided resistance training and electrical stimulation with voice-guided instructions. OBT consisted of six weekly sessions. Both methods involved anal strength, endurance, and coordination training. Primary outcome was change in weekly FI episodes. FI improvement was assessed with stool diaries, validated instruments (FISI, FISS, and ICIQ-B), and anorectal manometry using intention-to-treat analysis.
Thirty (F/M=26/4) FI patients (20 in HBT, 10 in OBT) participated. Weekly FI episodes decreased significantly after HBT (Δ±95% confidence interval 4.7±1.8, compared with baseline, p=0.003) and OBT (3.7±1.6, p=0.0003) and HBT was non-inferior to OBT (p=0.2). The FISI and FISS scores improved significantly in HBT group (p<0.02). Bowel pattern, bowel control, and quality of life (QOL) domains (ICIQ-B) improved significantly in HBT arm (p<0.023). Resting and maximum squeeze sphincter pressures significantly improved in both HBT and OBT groups and sustained squeeze pressure in HBT, without group differences.
Home biofeedback therapy is non-inferior to OBT for FI treatment. Home biofeedback is safe, effective, improves QOL, and through increased access could facilitate improved management of FI.
Home biofeedback therapy is non-inferior to OBT for FI treatment. Home biofeedback is safe, effective, improves QOL, and through increased access could facilitate improved management of FI.Health literacy is key to person-centred, preventative healthcare and is both a societal and individual responsibility. This feature describes work undertaken by Health Education England, the Community Health and Learning Foundation and NHS Library and Knowledge Services to raise awareness among NHS staff and other key partners of the impact of low health literacy. It highlights a range of health literacy resources and ideas for developing and adapting these tools for remote delivery during and post-pandemic. D.I.Obesity is a risk factor for erectile dysfunction and atherosclerosis. Lipocalin-2 is an adipocytokine with proinflammatory properties involved in several disorders with metabolic alterations. Our aim was to study the relation of serum lipocalin-2 and carotid artery intima-media thickness (CIMT) to obesity in erectile dysfunction. Serum lipocalin-2 and CIMT were measured in 25 obese and 25 nonobese eugonadal patients over forty with venogenic erectile dysfunction and 25 healthy controls. Their relation to different patient- and disease-related parameters was studied. Results revealed lipocalin-2 to be significantly higher in obese compared with nonobese patients and with controls, and in nonobese patients compared with controls. CIMT was lower in controls compared with both obese and nonobese patients. In obese and nonobese patients, lipocalin-2 was positively correlated with disease duration, body mass index, waist circumference and end-diastolic velocity. Lipocalin-2 was negatively correlated with the short form of the international index of erectile function scores in both groups. In conclusion, the elevated lipocalin-2 in obese and to a lesser extent in nonobese patients and its association with disease severity points to its potential value as a diagnostic marker and a possible therapeutic target that could ameliorate the metabolic derangement associated with erectile dysfunction.Instrumental variable (IV) methods are widely used in medical research to draw causal conclusions when the treatment and outcome are confounded by unmeasured confounding variables. One important feature of such studies is that the IV is often applied at the cluster level, for example, hospitals' or physicians' preference for a certain treatment where each hospital or physician naturally defines a cluster. This paper proposes to embed such observational IV data into a cluster-randomized encouragement experiment using nonbipartite matching. Potential outcomes and causal assumptions underpinning the design are formalized and examined. Testing procedures for two commonly used estimands, Fisher's sharp null hypothesis and the pooled effect ratio (PER), are extended to the current setting. We then introduce a novel cluster-heterogeneous proportional treatment effect model and the relevant estimand the average cluster effect ratio. This new estimand is advantageous over the structural parameter in a constant proportional treatment effect model in that it allows treatment heterogeneity, and is advantageous over the PER estimand in that it does not suffer from Simpson's paradox. We develop an asymptotically valid randomization-based testing procedure for this new estimand based on solving a mixed-integer quadratically constrained optimization problem. The proposed design and inferential methods are applied to a study of the effect of using transesophageal echocardiography during coronary artery bypass graft surgery on patients' 30-day mortality rate. R package ivdesign implements the proposed method.
To evaluate the acceptance of three-dimensional virtual reality programs and to explore the factors influencing the acceptance of the programs among the institutionalized older adults.
A cross-sectional explanatory study.
A total of 71 residents completed the program successfully. They were invited to join a 9-week program included eight activities related to horticultural therapy in a virtual environment. Data were collected by structured questionnaires from August 2018 to February 2019. Ten association hypotheses were derived from the literature review. Partial least squares structural equation modelling was used to examine the proposed hypotheses.
Program acceptance was defined as virtual reality practices and continuous usage intention. Frequency of practice was about 12 times during 9-week free-trial period, and the score of continuance usage intention was 13.06 (maximum value of 15). The findings indicated that virtual reality practices were significantly affected by presence and the presence wa virtual reality programs for the older adults.
Perfectionism is generally associated with worse mental health outcomes, though evidence suggests elements of it may be helpful. In light of these findings, we examined whether psychological skills like psychological flexibility and self-compassion moderated the relationship between perfectionism and wellbeing (i.e., quality of life, symptom impairment, and psychological distress).
Undergraduate students (N = 677) completed self-report measures.
A latent profile analysis identified three perfectionism groups (low, average, and high) based on four perfectionism subscales concern over mistakes, need for approval, rumination, and striving for excellence. Generally, we found that psychological flexibility and/or self-compassion buffered the impact of average and high perfectionism on quality of life and symptom impairment.
Our results support the utility of practicing psychological flexibility and/or self-compassion for people with average and high levels of perfectionism. Limitations include using a cross-sectional design and nonclinical sample.
