Bowel Preparation for Colonoscopy with Sodium Phosphate Solution versus Polyethylene Glycol-Based Lavage: A Multicenter Trial

Background: Adequate bowel preparation is essential for accurate colonoscopy. Both oral sodium phosphate (NaP) and polyethylene glycol-based lavage (PEG-ELS) are used predominantly as bowel cleansing modalities. NaP has gained popularity due to low drinking volume and lower costs. The purpose of this randomized multicenter observer blinded study was to compare three groups of cleansing (NaP, NaP + sennosides, PEG-ELS + sennosides) in reference to tolerability, acceptance, and cleanliness. Patient and Methods: 355 outpatients between 18 and 75 years were randomized into three groups (A, B, C) receiving NaP = A, NaP, and sennosides = B or PEG-ELS and sennosides = C. Gastroenterologists performing colonoscopies were blinded to the type of preparation. All patients documented tolerance and adverse events. Vital signs, premedication, completeness, discomfort, and complications were recorded. A quality score (0–4) of cleanliness was generated. Results: The three groups were similar with regard to age, sex, BMI, indication for colonoscopy, and comorbidity. Drinking volumes (L) (A = 4.33 + 1.2, B = 4.56 + 1.18, C = 4.93 + 1.71) were in favor of NaP (P = .005). Discomfort from ingested fluid was recorded in A = 39.8% (versus C: P = .015), B = 46.6% (versus C: P = .147), and C = 54.6%. Differences in tolerability and acceptance between the three groups were statistically not significant. No differences in adverse events and the cleanliness effects occurred in the three groups (P = .113). The cleanliness quality scores 0–2 were calculated in A: 77.7%, B: 86.7%, and C: 85.2%. Conclusions: These data fail to demonstrate significant differences in tolerability, acceptance, and preparation quality between the three types of bowel preparation for colonoscopy. Cleansing with NaP was not superior to PEG-ELS

Human-animal agency in reindeer management: Sami herders' perspectives on vegetation dynamics under climate change

Many primary livelihoods in Arctic and sub-Arctic regions experience accelerating effects of environmental change. The often close connection between indigenous peoples and their respective territories allows them to make detailed observations of how these changes transform the landscapes where they practice their daily activities. Here, we report Sami reindeer herders' observations based on their long-term inhabitance and use of contrasting pastoral landscapes in northern Fennoscandia. In particular, we focus on the capacity for various herd management regimes to prevent a potential transformation of open tundra vegetation to shrubland or woodland. Sami herders did not confirm a substantial, rapid, or large-scale transformation of treeless tundra areas into shrub-and/or woodlands. However, where they observe encroachment of open tundra landscapes, a range of factors was deemed responsible. These included abiotic conditions, anthropogenic influences, and the direct and indirect effects of reindeer. The advance of the mountain birch tree line was in some cases associated with reduced or discontinued grazing and firewood cutting, depending on the seasonal significance of these particular areas. Where the tree line has risen in elevation and/or latitude, herding practices have by necessity adapted to these changes. Exploiting the capacity of reindeer impacts on vegetation as a conservation tool offers time-tested adaptive strategies of ecosystem management to counteract a potential encroachment of the tundra by woody plants. However, novel solutions in environmental governance involve difficult trade-offs for ecologically sustainable, economically viable, and socially desirable management strategies

Evaluation of an electronic warfarin nomogram for anticoagulation of hemodialysis patients

<p>Abstract</p> <p>Background</p> <p>Warfarin nomograms to guide dosing have been shown to improve control of the international normalized ratio (INR) in the general outpatient setting. However, the effectiveness of these nomograms in hemodialysis patients is unknown. We evaluated the effectiveness of anticoagulation using an electronic warfarin nomogram administered by nurses in outpatient hemodialysis patients, compared to physician directed therapy.</p> <p>Methods</p> <p>Hemodialysis patients at any of the six outpatient clinics in Calgary, Alberta, treated with warfarin anticoagulation were included. Two five-month time periods were compared: prior to and post implementation of the nomogram. The primary endpoint was adequacy of anticoagulation (proportion of INR measurements within range ± 0.5 units).</p> <p>Results</p> <p>Overall, 67 patients were included in the pre- and 55 in the post-period (with 40 patients in both periods). Using generalized linear mixed models, the adequacy of INR control was similar in both periods for all range INR levels: in detail, range INR 1.5 to 2.5 (pre 93.6% (95% CI: 88.6% - 96.5%); post 95.6% (95% CI: 89.4% - 98.3%); p = 0.95); INR 2.0 to 3.0 (pre 82.2% (95% CI: 77.9% - 85.8%); post 77.4% (95% CI: 72.0% - 82.0%); p = 0.20); and, INR 2.5 to 3.5 (pre 84.3% (95% CI: 59.4% - 95.1%); post 66.8% (95% CI: 39.9% - 86.0%); p = 0.29). The mean number of INR measurements per patient decreased significantly between the pre- (30.5, 95% CI: 27.0 - 34.0) and post- (22.3, 95% CI: 18.4 - 26.1) (p = 0.003) period. There were 3 bleeding events in each of the periods.</p> <p>Conclusions</p> <p>An electronic warfarin anticoagulation nomogram administered by nurses achieved INR control similar to that of physician directed therapy among hemodialysis patients in an outpatient setting, with a significant reduction in frequency of testing. Future controlled trials are required to confirm the efficacy of this nomogram.</p

What are the basic self-monitoring components for cardiovascular risk management?

<p>Abstract</p> <p>Background</p> <p>Self-monitoring is increasingly recommended as a method of managing cardiovascular disease. However, the design, implementation and reproducibility of the self-monitoring interventions appear to vary considerably. We examined the interventions included in systematic reviews of self-monitoring for four clinical problems that increase cardiovascular disease risk.</p> <p>Methods</p> <p>We searched Medline and Cochrane databases for systematic reviews of self-monitoring for: heart failure, oral anticoagulation therapy, hypertension and type 2 diabetes. We extracted data using a pre-specified template for the identifiable components of the interventions for each disease. Data was also extracted on the theoretical basis of the education provided, the rationale given for the self-monitoring regime adopted and the compliance with the self-monitoring regime by the patients.</p> <p>Results</p> <p>From 52 randomized controlled trials (10,388 patients) we identified four main components in self-monitoring interventions: education, self-measurement, adjustment/adherence and contact with health professionals. Considerable variation in these components occurred across trials and conditions, and often components were poorly described. Few trials gave evidence-based rationales for the components included and self-measurement regimes adopted.</p> <p>Conclusions</p> <p>The components of self-monitoring interventions are not well defined despite current guidelines for self-monitoring in cardiovascular disease management. Few trials gave evidence-based rationales for the components included and self-measurement regimes adopted. We propose a checklist of factors to be considered in the design of self-monitoring interventions which may aid in the provision of an evidence-based rationale for each component as well as increase the reproducibility of effective interventions for clinicians and researchers.</p

Infective endocarditis in intravenous drug abusers: an update

Infective endocarditis despite advances in diagnosis remains a common cause of hospitalization, with high morbidity and mortality rates. Through literature review it is possible to conclude that polymicrobial endocarditis occurs mainly in intravenous drug abusers with predominance in the right side of the heart, often with tricuspid valve involvement. This fact can be associated with the type of drug used by the patients; therefore, knowledge of the patient's history is critical for adjustment of the therapy. It is also important to emphasize that the most common combinations of organisms in polymicrobial infective endocarditis are: Staphylococcus aureus, Streptococcus pneumonia and Pseudomonas aeruginosa, as well as mixed cultures of Candida spp. and bacteria. A better understanding of the epidemiology and associated risk factors are required in order to develop an efficient therapy, although PE studies are difficult to perform due to the rarity of cases and lack of prospective cohorts.This work was supported by Portuguese Foundation for Science and Technology (FCT) through the grants SFRH/BPD/47693/2008, SFRH/BPD/20987/2004 and SFRH/BPD/72632/2010 attributed to Claudia Sousa, Claudia Botelho and Diana Rodrigues, respectively

The need for transformative changes in the use of Indigenous knowledge along with science for environmental decision‐making in the Arctic

© 2020 The Authors. 1. Recent attention to the role of Indigenous knowledge (IK) in environmental monitoring, research and decision-making is likely to attract new people to this field of work. 2. Advancing the bringing together of IK and science in a way that is desirable to IK holders can lead to successful and inclusive research and decision-making. 3. We used the Delphi technique with 18 expert participants who were IK holders or working closely with IK from across the Arctic to examine the drivers of progress and limitations to the use of IK along with science to inform decision-making related to wildlife, reindeer herding and the environment. We also used this technique to identify participants' experiences of scientists' misconceptions concerning IK. 4. Participants had a strong focus on transformative change relating to the structure of institutions, politics, rights, involvement, power and agency over technical issues advancing or limiting progress (e.g. new technologies and language barriers). 5. Participants identified two modes of desirable research: coproducing knowledge with scientists and autonomous Indigenous-led research. They highlighted the need for more collaborative and coproduction projects to allow further refinement of approaches and more funding to support autonomous, Indigenous-led research. 6. Most misconceptions held by scientists concerning IK that were identified by participants related to the spatial, temporal and conceptual scope of IK, and the perceived need to validate IK using Western science. 7. Our research highlights some of the issues that need to be addressed by all participants in research and decision-making involving IK and science. While exact approaches will need to be tailored to specific social-ecological contexts, consideration of these broader concerns revealed by our analysis are likely to be central to effective partnerships.Anglia Ruskin University; EC H2020 Projects INTAROS and CAPARDUS. Grant Numbers: 727890, 869673; Nordic Council of Minister