98 research outputs found

    Surrogate consent for critical care research: exploratory study on public perception and influences on recruitment

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    INTRODUCTION: Critical Care research involves an increasing level of technical and clinical interventions for the unconscious patient. If the general public has a negative (unfavourable) view of surrogate consent, low recruitment rates are likely. Results bias will be introduced if study populations are small, hindering knowledge generation and transfer through research. In the rapidly expanding healthcare industry of South East Asia, opportunities for critical care research will grow given a positive willingness (favourability) by the general public to act as a surrogate in the consent process when the (unconscious) patient cannot consent for him/herself. METHODS: To determine public willingness for surrogate consent, a quantitative cross-sectional study was undertaken at a University Teaching Hospital in South East Asia during a three month interval. Four hypothetical critical care research scenarios were presented and responses from the public were analysed using a three-part questionnaire. RESULTS: Three hundred and five members of the public were recruited. In general, participants had a positive view of research. The level of education was significantly associated with a person's views about research especially in studies regarded as high risk. For low risk studies, a person's perception of research and willingness to be recruited to a study in the event that they were the (unconscious) patient, was the same whether they were the study subject or the person (legally acceptable representative) giving surrogate consent' on behalf of another (spouse, parent, child). Across all study scenarios, 60-80% of the public preferred to be approached by doctors to discuss the surrogate consent process. CONCLUSION: Given the hypothetical scenarios presented in this study, the odds of a person having a positive view and willingness to be consented to a critical care research study on the advice of another (surrogate consent) was greater than for those who had a negative or unfavourable view. Nurses may be disadvantaged in leading on the recruitment process due to a preference for information to be delivered by medically qualified clinicians. In the setting of South East Asia, cultural attitudes to nurse-led research in critical care must be taken in to consideration in the multidisciplinary approaches to building the research team

    Bone turnover biomarkers in obese postmenopausal Saudi women with type-ІІ diabetes mellitus

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    Background: There is a high prevalence of diabetes mellitus type-2 (T2DM) and osteoporosis are problems worldwide. In this study, we evaluated the correlation between T2DM and bone turnover in diabetic obese postmenopausal Saudi women.Subjects and Methods: The present study included total of 65 T2-DM obese postmenopausal Saudi women, (36 uncontrolled, 29 controlled) .The following serum biochemical parameters were evaluated [fasting blood glucose (FBG),total calcium (Ca), phosphorus (Pi), parathyroid hormone (PTH), 1,25-(OH)2Vitamin D3 ,osteocalcin (OC), procollagen (PICP) and cathepsin k (Cath K) ].Results: Serum OC levels were significantly decreased in diabetic obese postmenopausal group compared to their respective healthy group (P < 0.004). PICP and Cath K were significantly elevated in diabetic postmenopausal group compared to the healthy group ( P < 0.024 & 0.001). A significant elevation in 1,25(OH)2 Vitamin D3, Ca and Pi levels in diabetic obese postmenopausal patients group compared to the healthy group. However, a non-significant changes was observed in serum PTH level between different groups.Conclusion: In this study, the changes in the biochemical parameters and bone turnover markers in obese women are strong risk factors for diabetes development that may contribute to osteopenia and osteoporosis. The study showed the strong effect of T2DM on biochemical markers of bone turnover in obese postmenopausal Saudi women.Keyword: Diabetes mellitus type-2, Bone markers, Postmenopausa

    Rebamipide Does Not Protect Against Naproxen-induced Gastric Damage: A Randomized Double-blind Controlled Trial

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    Rebamipide is a gastroprotective agent with promising results against gastric damage induced by non-steroidal anti-inflammatory drugs. The present study evaluated if rebamipide protects against naproxen-induced gastric damage in healthy volunteers. Changes in gastric PGE2 tissue concentration were also evaluated. Methods: After a preliminary endoscopy to rule out previous gastric macroscopic damage, twenty-four healthy volunteers of both sexes were divided into 2 groups. One group received sodium naproxen 550 mg b.i.d. plus placebo for 7 days, while the other group received sodium naproxen 550 mg b.i.d. plus rebamipide 100 mg b.i.d. At the end of treatment, a new endoscopy was performed. Gastric macroscopic damage was evaluated by the Cryer score and by the modified Lanza score. The primary outcome measure of the trial was the macroscopic damage observed in each treatment group at the end of treatment. Biopsies were collected at both endoscopies for PGE2 quantification and histopathological analysis (secondary outcomes). Tissue PGE2 was quantified by ELISA. The randomization sequence was generated using 3 blocks of 8 subjects each. Volunteers and endoscopists were blind to whether they were receiving rebamipide or placebo. Results: All recruited volunteers completed the trial. Sodium naproxen induced gastric damage in both groups. At the end of the study, median Cryer score was 4 in both groups (Difference = 0; 95% CI = -1 to 0; p = 0.728). In the placebo group, the mean tissue PGE2 concentration was 1005 +/- 129 pg/mL before treatment and 241 +/- 41 pg/mL after treatment (p < 0.001). In the rebamipide group, the mean tissue PGE2 concentration was 999 +/- 109 pg/mL before treatment, and 168 +/- 13 pg/mL after treatment (p < 0.001). There was no difference in mean tissue PGE2 between the two groups (difference = 5; 95% CI from -334.870 to 345.650; p = 0.975). No significant change was observed at the histopathological evaluation, despite the evident macroscopic damage induced by naproxen. Conclusion: Rebamipide does not protect against naproxen-induced gastric damage in healthy volunteers.16Biolab Industria Farmaceutica Ltd

    Use of different electrical stimulations for treating pain in women with temporomandibular disorders

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    OBJECTIVE: To analyze pain intensity in individuals with temporomandibular disorder (TMD) who were treated with ten sessions of transcutaneous electrical nerve stimulation (TENS) or high voltage electrical stimulation (HVES). METHODS: Twenty-four women (22.98±1.86 years old) with a diagnosis of TMD in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were selected. 60% of the subjects had a diagnosis of TMD classified as group Ia and 40% as Ia and IIa. They were divided into two groups named the TENS group (TG) and the high voltage group (HVG). Each individual received ten applications of either TENS (10Hz, modulated at 50%, 200µs and motor threshold intensity) or HVES (10Hz, twin pulses of 20µs each at intervals of 100µs between the twin pulses, 100volts and positive pole) twice a week for 30 minutes. To measure the pain intensity, a visual analog scale (VAS) was used. Statistical analyses were performed using Student's t test and simple linear regression. RESULTS: Comparison of the pre and post-TENS conditions showed diminished pain intensity (p<0.05) at most sessions except for sessions 6, 7 and 8. In contrast, HVES reduced the pain intensity at all sessions (p<0.05). Evaluation of the pre-application values showed that both treatments decreased the pain intensity uniformly over the ten sessions (p<0.05). CONCLUSIONS: TENS and HVES both promoted reductions in pain intensity in women with TMD. HVES is a therapeutic resource recommended for such patients.OBJETIVO: Analisar a intensidade da dor em indivíduos com disfunção temporomandibular (DTM) tratados com dez sessões de estimulação elétrica nervosa transcutânea (TENS) ou estimulação elétrica de Alta Voltagem (EEAV). MÉTODOS: Foram selecionadas 24 mulheres (22,98±1,86 anos) com diagnóstico de DTM, segundo o Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), sendo 60% com diagnóstico de DTM do grupo Ia e 40% Ia e IIa. As voluntárias foram divididas em dois grupos denominados grupo TENS (GT) e Grupo Alta Voltagem (GAV). Em ambos os grupos as voluntárias receberam dez aplicações da TENS (10Hz modulada em 50%, 200 µs e intensidade no limiar motor) ou da EEAV (10Hz, pulsos gêmeos com 20µs cada e intervalo 100µs interpulsos gêmeos, 100Volts e pólo positivo) duas vezes por semana por 30 minutos. Para mensurar a intensidade da dor, foi utilizada a escala visual analógica (EVA). Para análise estatística, utilizou-se teste t de Student e análise de regressão linear simples. RESULTADOS: Comparando-se as condições pré e pós TENS observa-se uma redução na intensidade da dor (p<0,05) na maioria das sessões, exceto na sexta, sétima e oitava, enquanto a EEAV reduziu a intensidade da dor (p<0,05) em todas as sessões. Avaliando-se os valores pré-aplicação, os dois recursos diminuíram a intensidade de dor de forma uniforme ao longo das dez sessões (p<0,05). CONCLUSÕES: A TENS e a EEAV promoveram redução da intensidade da dor em mulheres com DTM, sendo a EEAV mais um recurso indicado para o tratamento desses pacientes.47648

    The impact of changing wildfire regimes on wood availability from portuguese forests

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    This article belongs to the special issue: Fire policies and practices in Europe: solving the Fire ParadoxThe perception of the good capability of the Portuguese mainland for timber production has sustained forest expansion policies during the twentieth century. These policies led to an increase of production forests, maritime pine (Pinus pinaster) first and eucalyptus (Eucalyptus globulus) later to support establishment and development of wood based industries (sawn, pulp and paper). The most recent forest inventory from 2005/6 estimated an area of 885,000 ha for maritime pine (8.9% of the country) and 740,000 ha for eucalyptus (7.5%). Today wood based industries (sawn, pulp and paper) are important for jobs and economy, using essentially the raw material produced in the country. However, forests are at high risks of wildfires, with pine and eucalyptus burning at an annual rate of 3–4% between 1996 and 2005. This resulted in great concerns about the sustainability of the national supply of wood to forest industries. As a consequence the National Forest Strategy (DGRF, 2007) recognized the decrease of risks associated with wildfires as a main policy objective. We predict the effect of different wildfire scenarios on wood availability for pine and eucalyptus forests with Markov chain models, by using national forest inventory and wildfire data

    EQ-5D in skin conditions: an assessment of validity and responsiveness

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    Aims and objectives This systematic literature review aims to assess the reliability, validity and responsiveness of three widely used generic preference-based measures of health-related quality of life (HRQL), i.e., EQ-5D, Health Utility Index 3 (HUI3) and SF-6D in patients with skin conditions. Methods A systematic search was conducted to identify studies reporting health state utility values obtained using EQ-5D, SF-6D, or HUI3 alongside other HRQL measures or clinical indices for patients with skin conditions. Data on test-retest analysis for reliability, known group differences or correlation and regression analyses for validity, and change over time or responsiveness indices analysis were extracted and reviewed. Results A total of 16 papers reporting EQ-5D utilities in people with skin conditions were included in the final review. No papers for SF-6D and HUI3 were found. Evidence of reliability was not found for any of these measures. The majority of studies included in the review (12 out of 16) examined patients with plaque psoriasis or psoriatic arthritis and the remaining four studies examined patients with either acne, hidradenitis suppurativa, hand eczema, or venous leg ulcers. The findings were generally positive in terms of performance of EQ-5D. Six studies showed that EQ-5D was able to reflect differences between severity groups and only one reported differences that were not statistically significant. Four studies found that EQ-5D detected differences between patients and the general population, and differences were statistically different for three of them. Further, moderate-to-strong correlation coefficients were found between EQ-5D and other skin-specific HRQL measures in four studies. Eight studies showed that EQ-5D was able to detect change in HRQL appropriately over time and the changes were statistically significant in seven studies. Conclusions Overall, the validity and responsiveness of the EQ-5D was found to be good in people with skin diseases, especially plaque psoriasis or psoriatic arthritis. No evidence on SF-6D and HUI3 was available to enable any judgments to be made on their performance
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