Abdidaniel5106

Objectives Given the ethnic/racial disparities in end-of-life care, this study aimed to describe and identify factors affecting engagement in three types of advance care planning including informal talk, living will, and durable power of attorney for health care among ethnic/racial minority older adults. Living will refers to any written instruction about medical treatments at the end-of-life while durable power of attorney for health care allows someone to make a health care decision when an individual is incapable of making a reasoned decision.Design We used a subset of racial/ethnic minority groups drawn from the second wave of the National Health Aging and Trends Survey (n = 543) collected in 2012.Results The descriptive result showed that informal talk (60%) happened most followed by durable power of attorney for health care (30%) and living will (26.5%) completion. Multivariate logistic regression analyses found that higher education and lower preference toward life-sustaining treatment were associated with engagement in all three types of advance care planning. Having multimorbidity and U.S. born were associated with having informal talk. Non-Hispanic others were more likely to have informal talk and complete durable power of attoreny for health care to compared to Blacks. Furthermore, married older adults were more likely to complete living wills compared to those separated/divorced or never married.Conclusions Our findings about different factors affecting engagement in advance care planning indicate that we may need targeted approaches to promote each type of advance care planning for ethnic/racial minority older adults.Objective To review phase II and III clinical trial data to evaluate the efficacy and safety of the halobetasol propionate/tazarotene (HP/TAZ) combination lotion (Duobrii), a medication approved by the Food and Drug Administration in April 2019 for adults with plaque psoriasis. Data Sources A systematic search (January 2005 to July 2019) of MEDLINE (PubMed) and EMBASE databases was performed using the terms halobetasol, tazarotene, halobetasol/tazarotene, Duobrii, and IDP-118. Study Selection and Data Extraction Relevant English-language articles reporting on phase II and phase III clinical trials were included. Data from the individual trials were extracted independently and then cross-checked to ensure accuracy. Data Synthesis HP/TAZ was safe and efficacious compared with HP alone, TAZ alone, or vehicle. More patients achieved treatment success, described as a ≥2-grade improvement on Investigator Global Assessment Scale, over 8 weeks of treatment and at the 4-week follow-up after treatment cessation. The most common adverse events were dermatitis, pain, and pruritus, which occurred more often in the TAZ groups compared with the HP/TAZ cohorts. Relevance to Patient Care and Clinical Practice The once-daily HP/TAZ combination lotion simplifies psoriasis treatment and may facilitate adherence, which may improve psoriasis outcomes. Conclusions HP/TAZ combination lotion is efficacious and safe for plaque psoriasis treatment, with more patients achieving end points and fewer side effects than in HP, TAZ, or vehicle-treated controls. Drug synergy may play a role. Importantly, patient adherence to a once-daily combinational therapy is likely to contribute to efficacy.OBJECTIVE To develop a Decision Quality (DQ) tool to measure parents' DQ concerning ventilation tube (VT) insertion in their children. METHOD Parental survey during 2017 to 2018 in a tertiary care pediatric otolaryngology clinic comparing a validated Decisional Conflict (DC) scale with a DQ instrument including Shared Decision-Making (SDM) scale, parental treatment goals, and knowledge about VT. RESULTS Of 100 parent participants, 83% were mothers and 14% were fathers. Selleck Coelenterazine 94% elected VT insertion, 6% elected monitoring or deferred the decision. 44% of the patients were less then 18 months, 42% were 19 months to 3 years, and the rest were older. The mean DC score was 8.26 out of 100 (95% CI 4.82-11.69), indicating low DC. Mean DQ score was 82.45 out of 100 (95% CI 80.18-84.72), including mean SDM of 87.71 (95% CI 83.53-91.88,), mean knowledge score of 87.5% (95% CI 84.56-91.59) and mean values score of 7.16 (95% CI 6.90-7.41). Comparisons between those who elected VT and those who did not showed that electors had lower DC scores (7.15 vs 24.74, P less then .001), higher DQ scores (83.00 vs 72.61, P = .028) with higher SDM scores (88.70 vs 70.22, P = .044) and higher values score (7.20 vs 6.36, P = .034). link2 Cronbach alpha for the DQ scale was 0.76. Spearman's rho for DQ score versus DC score was -0.458, P less then .001. CONCLUSIONS DQ, as measured with this tool, was higher when parents chose to place tubes. Our DQ instrument has potential use for study of why parents may decline VT when their child meets criteria for them.BACKGROUND AND OBJECTIVES Individual differences in acute and chronic anxiety have been linked to changes in working memory ability, though evidence for differences in specifically visual working memory performance has been inconsistent. The present study examined the role of both trait anxiety and induced feelings of apprehension on visual working memory performance. DESIGN 2 (Noise) x 2 (Distraction) within-person design with anxiety as a between-person factor. METHODS Forty-six participants recruited via online advertisement completed a change detection task, memorizing the orientations of rectangular bars presented either alone or among additional distractors, comparing this to a subsequent test display. Trait anxiety levels were measured by self-report questionnaire. To induce apprehension, participants completed some experimental blocks where loud aversive white noise could be presented at low probability. RESULTS Results of ANOVA and ANCOVA models showed that neither trait anxiety nor apprehension affected memory performance when only relevant objects were shown. However, memory performance was impaired when distractor objects were presented, and this effect was exacerbated under apprehension particularly for high trait anxious individuals. CONCLUSIONS Results suggest that induced apprehension and trait anxiety have little influence on visual working memory capacity, instead primarily disrupting distractor filtering efficiency.Interdisciplinary rounding has been shown to improve patient safety and provider engagement. Many models for interdisciplinary rounding have been proposed but few focus on preserving bedside medical education. The authors changed the interdisciplinary bedside rounding model to accommodate more time for medical education. The objective was to assess perceptions of communication, care coordination, and teamwork surrounding this change. Resident and attending physicians and unit-based nursing staff completed an anonymous online survey prior to and following the rounding intervention. Length of stay on medical units also was monitored prior to and following the rounding intervention. Following the intervention, there were perceived improvements in interdisciplinary communication, care coordination, and teamwork, and there were no significant changes in length of stay.BACKGROUND In Canada, cardiovascular disease is the second most common cause of death. A subset of these patients will require a cardiovascular implantable electronic device (CIED). An estimated 200 000 Canadians are living with a CIED. CIEDs can improve life and prevent premature death. However, when patients reach the end of their lives, they can pose a challenge. An example of which is a painful shock delivered from an implantable cardioverter defibrillator (ICD) for an arrhythmia in a dying patient. Receiving a shock at the end of life (EOL) is unacceptable in an age when we aim to ease the suffering of the dying and allow for a comfortable death. METHODS As a quality standard of practice, all clinicians are expected to engage in EOL conversations in patients requiring CIED deactivation. Due to the potential discomfort of an ICD shock, specific conversations about deactivation of an ICD are encouraged. A process improvement approach was developed by our hospital that included an advance care planning simulation lab, electronic documentation and a standardized comfort measures order set that includes addressing the need for ICD deactivation at EOL. RESULTS EOL conversations are complex. Health care providers have been equally challenged to have conversations about ICD deactivation. Standardization of the process of ICD deactivation ensures an approach to EOL which respects the individuality of patients and promotes quality dying. CONCLUSION Our hospital is committed to assisting clinicians to provide quality care by improving conversations about EOL care. On the basis of a synthesis of existing literature, we describe the importance of and the ideal process for having EOL conversations in patients about ICD deactivation at the EOL.Tanzania has recently adapted World Health Organization antiretroviral guidelines that include integrase strand transfer inhibitor (INSTIs) in the first-line regimen. However, evidence lack on integrase (IN) gene polymorphisms in viral strains circulating in Tanzania. Here, we characterise IN gene polymorphisms in viral strains circulating in Dar es Salaam, Tanzania prior to introduction of INSTIs. Plasma viral RNAs were prepared from 158 HIV-1-infected subjects, including 111 treated but viremic (INSTIs naïve) subjects. A part of pol gene encompassing integrase-coding region was amplified and directly sequenced by Sanger sequencing method. Subtype analysis revealed subtype A1, C, D and inter-subtype recombinants were 42%, 38%, 11% and 9% respectively. Though multiple subtypes co-circulate, IN gene exhibited a relatively conserved amino acid sequence pattern with average Shannon entropy score of 0.16. No major INSTIs resistance mutations were found, however accessory resistance mutations at positions T97A, E157Q, G163E/K and 128A/T were detected in 5% of subjects.Iran is a great country with a long history of civilization and medicine. link3 Following the increase in the prevalence of multiple sclerosis (MS), Iranian scientists and physicians started considering this disease and its outcomes in Iran. The first MS paper published by Iranian scientists dates back to 1963, when a case of hereditary spastic ataxia mimicking MS was reported. With the cooperation of his colleagues, Prof. Jamshid Lotfi conducted the first MS-related paper. The Iranian MS Society was established in 1998 in Iran, and is currently a member of the MS International Federation (MSIF). Progressively, after the scientific development of Iranian universities and recognizing the importance of the disease, the first specialized MS ward was established in Sina hospital by Prof. Mohammad Ali Sahraian and was followed by the establishment of the first MS research center. MS Society is presently quite active and the Iranian MS congress is annually held in one of the Iranian universities to review the most recent achievements in the field of the disease. The present study aims to illustrate the history of the efforts made on the way, and attempts to introduce the people who took significant steps in this regard. © 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http//creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.