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rammes. The key issues highlighted by the students included limited clinical exposure to sepsis patients and lack of confidence in recognising early signs of sepsis.

Among respiratory diseases, asthma is one of the most burdensome disorder worldwide. Growing evidence disclose gut dysbiosis may contribute to asthma via the gut-lung axis. Constipation can lead to alteration of the gut microflora. The clinical impact of constipation on asthma has not been researched. Therefore, we aim to assess the risk of asthma in constipated patients by a nationwide population-based cohort study.

We analysed 86860 constipated patients and 86860 individuals without constipation between 1999 and 2013 from the Taiwanese National Health Insurance Research Database. Analysis of propensity score was utilised to match age, gender, comorbidities and medications at a ratio of 11. Besides, multiple Cox regression analysis was performed to evaluate the adjusted hazard ratio of asthma. Furthermore, sensitivity tests and stratified analysis were conducted.

The incidence of asthma was 10.4 per 1000 person-years in the constipation group, which was higher than the rate of 5.7 per 1000 person-yearsns should be aware of the possibility of asthma in constipated people. Further research is warranted to investigate the possible pathological mechanisms of this association.

To examine the association between hip and knee osteoarthritis (OA) and falls. Potentially relevant articles that examine the association between hip, knee, radiological, and self-reported OA and falls were retrieved from PubMed, EMBASE, Scopus, and Web of Science up until March of 2020.

The pooled risk ratios (RRs) as well as their related 95% confidence intervals (CIs) were calculated. Statistic and subgroup analyses were performed. A total of 21 studies involving 146965 participants were included.

No association was found between hip OA and falls. The pooled RRs value suggested a higher prevalence of falls in knee OA patients (RR=1.35, 95% CI 1.20 to 1.51, P<.00001) and self-reported OA (RR=1.33, 95% CI 1.23 to 1.45, P<.00001) than in non-OA subjects. The pooled RR value suggested no difference between prevalence of falls in radiological OA patients compared to non-OA subjects (RR=1.82, 95% CI 0.89 to 3.73, P=.10). Both radiological and self-reported knee OA seem to be positively associated with falls, while no obvious association was found between hip OA and falls.

Therefore, knee OA is a risk factor for falls which should be closely monitored.

Therefore, knee OA is a risk factor for falls which should be closely monitored.

In the context of increasing incidence of stroke in working aged adults, there is a specific need to explore the views of working aged adults with post-stroke aphasia, whose communication difficulties may result in restricted social participation, loss of employment and changed relationship and parenting roles. This study aimed to explore the perspectives of working aged adults with post-stroke aphasia in relation to social participation and living well with aphasia (LWA).

We conducted qualitative interviews with 14 people with post-stroke aphasia (PWA). Data were analysed following principles of reflexive, thematic analysis. Patient or Public Contribution A Public and Patient Involvement aphasia advisory group inputted into the study design and interpretation of data.

Social participation spanned 5 themes Relationships and roles; Social support; Peer network, Aphasia awareness; and Employment and training. Meaningful, interesting social participation for LWA is individually defined. Working aged PWA ma setting the aphasia agenda.Evaluation of nurses' perceptions towards medication administration errors (MAEs) reporting is a key aspect for improving patient safety, and prevention of errors repetition. Thus, this study has evaluated nurses' behaviour towards MAEs reporting practice, and factors contributing to their under-reporting of errors. This is a cross-sectional survey-based study that was conducted during February 2021. During the study period, a convenience sample of nurses working at Jordan university hospital was invited to voluntarily participate in the study and to fill an online questionnaire uploaded on an electronic data collection platform. The questionnaire assessed nurses MAEs reporting practice, their perception towards factors contributing to MAEs, factors associated with under-reporting of MAEs, and their perception towards MAEs preventive measures. A total of 150 nurses responded to the electronic questionnaire, with 54.0% of them (n = 81) were males and the majority had a bachelor's degree in nursing (n = 138, 92.0%). Regarding MAE reporting's practice, 78% of them (n = 117) indicated that they are always/often report MAEs even if it is not possible to improve the patient's health status. With regard to factors contributing to MAEs, results showed that "insufficient staffing" was the most common reason contributing to MAEs occurrence reported by nurses (n = 114, 94.0%). Personal fear from nursing administration was the primary cause of MAEs under-reporting (n = 98, 65.3%), while 94.0% of nurses (n = 141) agreed/strongly agreed that following the six rights is a way to prevent MAEs occurrence. This study indicates a positive reporting attitude towards MAEs. Nursing administration concerns were considered the main reason associated with the under-reporting of MAEs. This study shed the light on the deep need for continuous education programmes about the importance of the right MAEs reporting. As well, the need for effective and restricted rules in a non-punitive environment to prevent MAEs incidences.

Amyotrophic lateral sclerosis (ALS) is a progressive disease characterized by degeneration in the upper and lower motor neurons of the corticospinal tract, brain stem, and spinal cord. Recent studies have revealed that the disease does not present solely with motor neuron involvement. Accordingly, the aim of this study is to investigate the presence of cardiac autonomic impairment in patients diagnosed with ALS.

A total of 61 patients, who were diagnosed with ALS according to the Revised El Escorial Criteria (R-EEC), were included in this prospective study, in addition to the 29 healthy individuals, who were included in the study as controls. In order to assess the cardiac autonomic involvement, the presence of orthostatic hypotension was investigated, and transthoracic echocardiography and 24-hour electrocardiogram (ECG) using a Holter monitor were performed.

Orthostatic hypotension was detected in 14 (22.2%) patients. Holter electrocardiogram results of the patient group revealed statistically significantly lower heart rate variability (HRV) indicators in the time domain (SDNN, SDANN, SDNN index, rMSSD, and pNN50) and in the frequency domain (high frequency [HF], low frequency [LF], and very low frequency [VLF]) than those of the control group (P<.05).

Contrary to the popular opinion, cardiac autonomic dysfunction in patients with ALS can occur at any stage of the disease. Therefore, it is recommended that the patients are evaluated via periodic examinations during the follow-up period for cardiac autonomic involvement.

Contrary to the popular opinion, cardiac autonomic dysfunction in patients with ALS can occur at any stage of the disease. Therefore, it is recommended that the patients are evaluated via periodic examinations during the follow-up period for cardiac autonomic involvement.

Despite the relevance of assessing sexual knowledge in people with Intellectual Disability, there is a lack of appropriate assessment tools to measure this domain. The current study tests the psychometric properties of the new 'Inventory of Sexual Knowledge of people with Intellectual Disability' (ISK-ID).

345 individuals with mild intellectual disability completed the ISK-ID before and after the implementation of a sexual education program. Psychometric properties of the ISK-ID were analysed according to Multidimensional Item Response Theory (MIRT).

Its underlying factorial structure, along with parameters derived from the MIRT (item discrimination, difficulty, and participant's ability), support the use of the ISK-ID as a measure of sexual knowledge. Moreover, the ISK-ID was able to detect changes in the level of sexual knowledge resulting from educational interventions (i.e., responsiveness).

The ISK-ID is an appropriate assessment tool to measure sexual knowledge in men and women with mild intellectual disability.

The ISK-ID is an appropriate assessment tool to measure sexual knowledge in men and women with mild intellectual disability.

Use and dosing of guideline-directed medical therapy (GDMT) in patients with heart failure (HF) have been shown to be suboptimal. Among new users of GDMT in HF, we followed the real-life patterns of dose titration and discontinuation of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), beta-blockers, mineralocorticoid receptor antagonists (MRA) and angiotensin receptor-neprilysin inhibitors (ARNI).

New users were identified in health care databases in Sweden, UK and US between 2016-2019. Inclusion criterion was a recent HF hospitalization (HHF) triggering the initiation of GDMT. Patients were grouped by GDMT, i.e. ACEi, ARB, beta-blocker, MRA and ARNI, and stratified by initial dose. Follow-up was 12 months, until death or study end. selleckchem Outcomes were dose titration within each drug class, discontinuation and first HHF or death. Dose/discontinuation follow-up was assessed daily based on the coverage length of a filled prescription and reported on day 365. New users of ACEi hree countries with different health care and economies. Our data highlight the urgent need for moving away from long sequential approach when initiating HF treatment and for improving just-in-time decision support for patients and health care providers.Amniotic fluid embolism (AFE) is a rare but fatal obstetric complication, characterized by sudden cardiovascular collapse, respiratory failure, and disseminated intravascular coagulation. Maternal mortality associated with AFE is high, making early recognition and prompt treatment important. In AFE with cardiac arrest, survival following acute cardiopulmonary dysfunction is crucial. In recent years, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has attracted attention as an aggressive treatment for AFE with cardiac arrest. A 40-year-old woman experienced sudden cardiac arrest due to AFE during cesarean section. Cardiopulmonary resuscitation and VA-ECMO (also called percutaneous cardiopulmonary support) were initiated early. Finally, she recovered without any complications. VA-ECMO can provide temporary respiratory and hemodynamic support until cardiopulmonary function improves after a few days in intensive care. VA-ECMO should be considered as an early treatment for AFE with cardiac arrest.

We compared the effectiveness of the Babu and Magon uterine closure technique and unlocked double-layer uterine closure on the integrity and thickness of the uterine scar.

A randomized double-blind trial was performed at Hazrat-e Rasoul -e-Akram Hospital, Tehran, Iran, from March 2018 to December 2019, in 72 pregnant women who were candidates for cesarean section for the first time. Women were randomly assigned to the Babu and Magon uterine closure technique (intervention group, n=34) or double-layer closure of the uterine incision (control group, n=38). The primary outcome of the study was the frequency of myometrial defects at the site of the scar (niche), and a large niche. Secondary outcomes, including the time taken for uterine closure and postpartum hemorrhage (early and late), were compared between groups.

Adjacent myometrium thickness (AMT) between the two groups was not statistically significant. A niche was reported in 23.5% (8/34) and 50% (19/38) of women in the intervention and controls, respectively (p=0.