Interrater Reliability of Diagnostic Methods in Traditional Indian Ayurvedic Medicine

This study assesses the interrater reliability of Ayurvedic pulse (nadi), tongue (jivha), and body constitution (prakriti) assessments. Fifteen registered Ayurvedic doctors with 3–15 years of experience independently examined twenty healthy subjects. Subjects completed self-assessment questionnaires and software analyses for prakriti assessment. Weighted kappa statistics for all 105 pairs of doctors were computed for the pulse, tongue, and prakriti data sets. According to the Landis-Koch scale, the pairwise kappas ranged from poor to slight, slight to fair, and fair to moderate for pulse, tongue, and prakriti assessments, respectively. The average pairwise kappa for pulse, tongue, and prakriti was 0.07, 0.17, and 0.28, respectively. For each data set and pair of doctors, the null hypothesis of random rating was rejected for just twelve pairs of doctors for prakriti, one pair of doctors for pulse examination, and no pairs of doctors for tongue assessment. Thus, the results demonstrate a low level of reliability for all types of assessment made by doctors. There was significant evidence against random rating by software and questionnaire use and by the diagnosis preferred by the majority of doctors. Prakriti assessment appears reliable when questionnaire and software assessment are used, while other diagnostic methods have room for improvement

Randomized clinical trial comparing abluminal biodegradable polymer sirolimus-eluting stents with durable polymer sirolimus-eluting stents: Nine months angiographic and 5-year clinical outcomes

Background: The biodegradable polymer drug-eluting stents (DES) were developed to improve vascular healing. However, further data and longer-term follow-up are needed to confirm safety and efficacy of these stents. This randomized clinical trial aimed to compare safety and efficacy of 2 sirolimus-eluting stents (SES): Cordimax—a novel abluminal biodegradable polymer SES and Cypher Select—a durable polymer SES, at 9 months angiographic and 5-year clinical follow-up. Methods: We randomized 402 patients with coronary artery disease to percutaneous coronary intervention with Cordimax (n = 202) or Cypher select (n = 200). Angiographic follow-up was performed at 9 months after the index procedure and clinical follow-up annually up to 5 years. The primary endpoint was angiographic in-stent late luminal loss (LLL). Secondary endpoints included angiographic restenosis rate, target vessel revascularization (TVR), and major adverse cardiac events (MACEs; defined as cardiac death, myocardial infarction, or TVR) at 5-year follow-up. Results: Cordimax was noninferior to Cypher select for in-stent LLL (0.25 ± 0.47 vs 0.18 ± 0.49 mm; P = 0.587) and in-stent mean diameter stenosis (22.19 ± 12.21% vs 19.89 ± 10.79%; P = 0.064) at 9 months angiographic follow-up. The MACE rates were not different at 1 year (5.9% vs 4.0%, P = 0.376); however, MACE rates from 2 to 5 years were lower in the Cordimax group (6.8% vs 13.1%; P = 0.039). Conclusion: Abluminal biodegradable polymer SES is noninferior to durable polymer SES at 9-month angiographic and 1-year clinical follow-up. However, MACE rates from 2 to 5 years were less in the abluminal biodegradable polymer group.National Key Technology Research and Development Program in the Twelfth Five-year Plan Period of China (No. 2014BAI11B04)

Implementation of the concept of home hospitalisation for heart patients by means of telehomecare technology: integration of clinical tasks

<b>Purpose</b>: To explore how the implementation of the concept ‘Home hospitalisation of heart patients’ by means of telehomecare technology influences the integration of clinical tasks across healthcare sectors.<br><br> <b>Theory</b>: Inter-organisational theory.<br><br> <b>Methods</b>: The case study approach was applied. Triangulations of data collection techniques were used: documentary materials, participant observation, qualitative and focus group interviews.<br><br> <b>Results</b>: The clinical decision-making and task solving became multidisciplinary and integrated with the implementation of telehomecare and, therefore, complex in terms of the prescription and adjustment of patient medicine. Workflows between healthcare professionals across sectors changed from sequential to collective client flows. Pre-existing procedures for patient care, treatment, and responsibility were challenged. In addition, the number of tasks for the district nurses increased. Integration in the clinical task-solving area increases fragmentation in the knowledge technologies in a network perspective. Conclusions: Implementing the concept of ‘Home hospitalisation of heart patients’ by means of telehomecare technology will result in a more integrated clinical task-solving process that involves healthcare professionals from various sectors. Overall, the integration of clinical tasks between hospital and district nursing will result in a direct benefit for the heart patients

Dissection of the antimicrobial and hemolytic activity of Cap18: Generation of Cap18 derivatives with enhanced specificity

<div><p>Due to the rapid emergence of resistance to classical antibiotics, novel antimicrobial compounds are needed. It is desirable to selectively kill pathogenic bacteria without targeting other beneficial bacteria in order to prevent the negative clinical consequences caused by many broad-spectrum antibiotics as well as reducing the development of antibiotic resistance. Antimicrobial peptides (AMPs) represent an alternative to classical antibiotics and it has been previously demonstrated that Cap18 has high antimicrobial activity against a broad range of bacterial species. In this study we report the design of a positional scanning library consisting of 696 Cap18 derivatives and the subsequent screening for antimicrobial activity against <i>Y</i>. <i>ruckeri</i>, <i>A</i>. <i>salmonicida</i>, <i>S</i>. Typhimurium and <i>L</i>. <i>lactis</i> as well as for hemolytic activity measuring the hemoglobin release of horse erythrocytes. We show that the hydrophobic face of Cap18, in particular I13, L17 and I24, is essential for its antimicrobial activity against <i>S</i>. Typhimurium, <i>Y</i>. <i>ruckeri</i>, <i>A</i>. <i>salmonicida</i>, <i>E</i>. <i>coli</i>, <i>P</i>. <i>aeruginosa</i>, <i>L</i>. <i>lactis</i>, <i>L</i>. <i>monocytogenes</i> and <i>E</i>. <i>faecalis</i>. In particular, Cap18 derivatives harboring a I13D, L17D, L17P, I24D or I24N substitution lost their antimicrobial activity against any of the tested bacterial strains. In addition, we were able to generate species-specific Cap18 derivatives by particular amino acid substitutions either in the hydrophobic face at positions L6, L17, I20, and I27, or in the hydrophilic face at positions K16 and K18. Finally, our data showed the proline residue at position 29 to be essential for the inherent low hemolytic activity of Cap18 and that substitution of the residues K16, K23, or G21 by any hydrophobic residues enhances the hemolytic activity. This study demonstrates the potential of generating species-specific AMPs for the selective elimination of bacterial pathogens.</p></div

PBL and critical thinking disposition in Chinese medical students – A randomized cross-sectional study

 The purpose of this study was to explore the relationship of problem-based learning (PBL) and the development of critical thinking disposition (CT) and academic achievement in Chinese medical students using a cross-sectional randomized design. Medical students from China Medical University (CMU) were randomized to PBL or non-PBL teaching at the commencement of the study. After five years of study, CT was scored by a Chinese version of the California Critical Thinking Disposition Inventory (CCTDI-CV). The score achieved on a Computer Case Simulation (CCS) test evaluated academic performance. Total CT score was higher in PBL students (n=170) than non-PBL students (n=83) (304.7±36.8 vs. 279.2±39.4, p &lt; 0.01). Subscale CT-scores were significant in favor of PBL in six of the seven subscales (truth seeking, open-mindedness, analyticity, systematicity, inquisitiveness, maturity). There was no significant difference in terms of gender on the total CT score, though minor differences were seen in subscales favoring female PBL students. PBL students had higher CCS scores than non-PBL students, but not significantly (112.8±20.6 vs. 107.3±16.5; p=0.11). There was no significant correlation between CCS scores and CCTDI-CV results. Male students scored slightly higher on the CCS test compared to female students (male 113.4±18.9 vs. female 109.7±19.7), but the difference was not significant. This study concludes that in Chinese medical students, PBL teaching was related to a higher disposition of critical thinking, but not to improved academic skills

Ventricular tachycardia after administration of sildenafil citrate: a case report

<p>Abstract</p> <p>Background</p> <p>It has not previously been reported that sildenafil citrate causes malignant arrhythmias in humans.</p> <p>Case presentation</p> <p>A 41-year-old man developed sustained ventricular tachycardia following sildenafil citrate administration.</p> <p>Conclusion</p> <p>It cannot be dismissed that this patient experienced ventricular tachycardia as an adverse effect of sildenafil citrate administration.</p