Current opinions and recommendations of paediatric healthcare professionals - The importance of tablets:Emerging orally disintegrating versus traditional tablets

The appropriate prescribing of paediatric dosage forms is paramount in providing the desired therapeutic effect alongside successful medication adherence with the paediatric population. Often it is the opinion of the healthcare practitioner that dictates which type of dosage form would be most appropriate for the paediatric patient, with liquids being both the most commonly available and most commonly used. Orally disintegrating tablets (ODTs) are an emerging dosage form which provide many benefits over traditional dosage forms for paediatric patients, such as rapid disintegration within the oral cavity, and the reduction in the risk of choking. However the opinion and professional use of healthcare practitioners regarding ODT's is not known. This study was designed to assess the opinions of several types of healthcare professionals (n = 41) regarding ODTs, using a survey across two hospital sites. Results reaffirmed the popularity of liquids for prescribing in paediatrics, with 58.0% of participants preferring this dosage form. ODTs emerged as the second most popular dosage form (30.0%), with healthcare practitioners indicating an increasing popularity amongst patients in the hospital setting, belief with 63.0% of practitioners agreeing that many liquid formulations could be substituted with a suitable ODT. The desired properties of an ideal ODT were also identified by healthcare practitioners preferring a small, fast disintegrating tablet (90.2% and 95.1% respectively), with the taste, disintegration time and flavour being the three most important attributes identified (29.5%, 28.7% and 21.7% respectively). This study provided a pragmatic approach in assessing healthcare professional's opinions on ODTs, highlighting the ideas and thoughts of practitioners who are on the frontline of paediatric prescribing and treatment and gave an indication to their preference for ODT properties

Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital

<p>Abstract</p> <p>Background</p> <p>Individualized, nutritional support reduced undernutrition among older stroke patients and improved quality of life in our recent randomized, controlled trial. Weight control thus seems to be important after stroke, and methods for monitoring nutritional status need to be simple and non-invasive. Here we aimed to assess if the nutritional intervention altered body composition in men and women in this study cohort, and also to examine the correlation between the methods for assessing body-, fat- and fat-free mass.</p> <p>Methods</p> <p>Acute stroke patients > 65 years at nutritional risk were randomized to either individualized, nutritional treatment with energy- and protein rich supplementation (intervention, n = 58) or routine, nutritional care (control, n = 66) while in hospital. Body composition was assessed with anthropometry and bioelectrical impedance. The follow-up period was three months.</p> <p>Results</p> <p>During the first week while in hospital, weight loss was smaller in the intervention group compared with the controls (P = 0.013). After three months weight- and fat loss were significant in both men and women. Whereas no significant differences were found in changes in body composition between the male study groups, in the women both weight loss (P = 0.022) and fat loss (P = 0.005) was smaller in the intervention group compared with the controls. A high correlation (r = 0.87) between mid upper arm circumference (MUAC) and body mass index (BMI) was found.</p> <p>Conclusions</p> <p>Individualized nutritional support to older stroke patients in hospital was beneficial for maintaining an adequate body mass and body composition the first week and seemed to have a preventive effect on fat loss among women, but not among men after three months. Measurement of MUAC may be used in the assessment of nutritional status when BMI cannot be obtained.</p> <p>Trial registration</p> <p>This trial is registered with ClinicalTrials.gov, number NCT00163007.</p

Physiological changes to the swallowing mechanism following (Chemo)radiotherapy for head and neck cancer: a systematic review

Emerging research suggests that preventative swallowing rehabilitation, undertaken before or during (chemo)radiotherapy ([C]RT), can significantly improve early swallowing outcomes for head and neck cancer (HNC) patients. However, these treatment protocols are highly variable. Determining specific physiological swallowing parameters that are most likely to be impacted post-(C)RT would assist in refining clear targets for preventative rehabilitation. Therefore, this systematic review (1) examined the frequency and prevalence of physiological swallowing deficits observed post-(C)RT for HNC, and (2) determined the patterns of prevalence of these key physiological deficits over time post-treatment. Online databases were searched for relevant papers published between January 1998 and March 2013. A total of 153 papers were identified and appraised for methodological quality and suitability based on exclusionary criteria. Ultimately, 19 publications met the study’s inclusion criteria. Collation of reported prevalence of physiological swallowing deficits revealed reduced laryngeal excursion, base-of-tongue (BOT) dysfunction, reduced pharyngeal contraction, and impaired epiglottic movement as most frequently reported. BOT dysfunction and impaired epiglottic movement showed a collective prevalence of over 75 % in the majority of patient cohorts, whilst reduced laryngeal elevation and pharyngeal contraction had a prevalence of over 50 %. Subanalysis suggested a trend that the prevalence of these key deficits is dynamic although persistent over time. These findings can be used by clinicians to inform preventative intervention and support the use of specific, evidence-based therapy tasks explicitly selected to target the highly prevalent deficits post-(C)RT for HNC

Investigating the price of the New Zealand wool clip using modelling approaches

The price of the New Zealand wool clip has steadily decreased over the years and the incumbent practitioners are looking for ways to increase the price. The price of the wool is determined by the marketing approaches that are adopted. An auction system is one of the wool marketing approaches and a total of 45% of the New Zealand wool clip is traded via auction (WIN, 2007).This auction is the English open out-cry public auction which has been running for the last 150 years in New Zealand. The key players of the auction (buyers, brokers and growers) as well as the New Zealand government are trying to understand the reasons behind the steady decrease in the price of the New Zealand wool clip. Further, the incumbent practitioners are questioning the auction system and looking for alternative ways of wool marketing. In this study, an attempt is made to model auction data. The data is available from the only auction centre in the South Island of New Zealand in Christchurch. Analytical approaches are used in developing the models from the data. Before fitting the data into the models, the database is thoroughly cleaned and a necessary and sufficient set of the parameters is produced by developing the approximation equations. The probability distributions of the parameters in the data base are observed. Best fitted distributions for all physical parameters are observed in terms of three measures namely mean square error, the chi-square and Kolmogorov-Smirnov (K-S) goodness-of-fit hypothesis tests. The cleaned database is used in the models. The models are developed to predict the price of the different types of wool. The price from the auction centre and the predicted price are compared. The models based on linear regression analysis, multiple regression analysis and principal component analysis are developed. The developed regression models are tested for the goodness-of-fit against coefficient of determination, R² , which describes the proportion of variability in the data set accounted for by the model. The model from the principal component analysis is used for the possible dimensionality reduction in the data set. The developed models and the physical parameters of wool are discussed. The role of physical parameters that account for the price of wool in the auction system is investigated. It is hoped that the analysis of auction database and the developed models will help the practitioners of the New Zealand wool industry in better understanding the role of physical parameters of wool and the price formation of it

Psychometric Validation Of The Center For Epidemiological Studies Depression Scale In Head And Neck Cancer Patients

Objective The Center for Epidemiological Studies Depression Scale (CES-D) is a 20-item tool developed to screen for depression in the general population. To psychometrically evaluate and validate the CES-D scale for use in head and neck cancer (HNC) patients. Methods The CES-D was applied to 130 subjects at onset of radiation treatment and 3-months following treatment. Analysis was conducted via face and content validity using two expert raters, internal consistency was applied using Cronbach\u27s alpha, test retest reliability comparing baseline to 3-month application, concurrent validity was performed against the FACT-H&N and Pain Disability Index, construct validity was conducted via exploratory factor analysis. Results The sample was predominantly male receiving chemo radiation. Face validity was strong (α = 0.85). Significant difference was found in the mean score between depressed (CES-D cut point ≥ 16) vs. non-depressed (t = −15.84, p =.00) (95% CI = −17.18, −13.33). Internal consistency of the scale was high (α = 0.84). Test retest reliability (p \u3c.001) showed moderate-strong correlations (0.51), however was not sensitive to change in this sample across the study time period. Concurrent validity was strong (r = −0.77, 0.51). Factor analysis at baseline explained 54.92% of variance, with 3 distinct factors; depressed affect, somatic/retarded activity, and positive affect. In contrast to general populations, the factor ‘disturbed interpersonal skill’ was not retained. Conclusion Results confirm the reliability and validity of the CES-D as a measure of depression in HNC populations. Proposed cut off scores remain stable but scale responsiveness suggests caution when evaluating change over time in this population

Auction theory : bidder's perspective in a public out-cry English auction

This paper provides an overview of auction theory literature. We present a general review on literature of various auctions and focus ourselves specifically on an English auction. We are interested in modelling bidder's behavior in an English auction environment. And hence, we present an overview of the New Zealand wool auction followed by a model that would describe a bidder's decision making behaviour from the New Zealand wool auction. The mathematical assumptions in an English auction environment are demonstrated from the perspective of the New Zealand wool auction