Patients and Public Involvement in Patient Safety and Treatment Process in Hospitals Affiliated to Kashan University of Medical Sciences, Iran, 2013

Background: In the recent decades, healthcare providers had a perspective of benevolent paternalism. Nowadays, the patients’ role has changed and they have a significant obligation to participate in their caring decisions. Objectives: The current study aimed to investigate the involvement of patients and public in the patient safety and treatment process in hospitals affiliated to Kashan University of Medical Sciences, Kashan, Iran, 2013. Patients and Methods: A cross-sectional study was conducted in the hospitals affiliated to Kashan University of Medical Sciences in 2013. Subjects included all of the 18 chief managers, 10% of nurses in each hospital, and 375 patients. Data collection instruments included a questionnaire and a checklist designed according to the research objectives. Data analysis was performed using the SPSS ver. 13. Descriptive statistics, percentage and frequencies, were calculated for all variables and analyzed by Chi-square test. Results: In the treatment process, 81 patients (21.61%), 50 nurses (80.6%) and 15 chief managers (83.3%) had awareness about Patient Bill of Rights. In patient Safety, 19.73% of the patients stated that hospitals received their feedbacks. Management activities were weak in evaluation. All of the six hospitals (100%) had a defined process to perform satisfaction surveys’ quality improvement and patient authentication policy. Conclusions: Patient and public participation in Kashan hospitals are not adhered well. As the patient has an important role in improving the quality of services, more use of mass media especially local newspapers, hospital websites, and training programs are suggested to inform both the patients and public on their rights and roles in improving the healthcare services

Health-related quality of life and medication adherence in elderly patients with epilepsy

© 2019 Polish Neurological Society. Objective. Considering the high prevalence of epilepsy in the elderly and the importance of maximising their quality of life (QoL), this study aimed to investigate the relationship between medication adherence and QoL, and the mediating effects of medication adherence on the association between serum antiepileptic drug (AED) level and seizure severity with QoL in elderly epileptics. Methods. In a longitudinal study, 766 elderly patients with epilepsy who were prescribed a minimum of one antiepileptic drug were selected by convenience sampling method. A Medication Adherence Report Scale (MARS-5) questionnaire was completed at the baseline. Seizure severity and QoL were assessed after six months using the Liverpool Seizure Severity Scale (LSSS) and the QoL in Epilepsy (QOLIE-31) questionnaires respectively. Serum level of AED was also measured at six-month follow-up. Results. Medication adherence was significantly correlated with both seizure severity (β = -0.33, p < 0.0001) and serum AED level (β = 0.29, p < 0.0001) after adjusting for demographic and clinical characteristics. Neither QoL nor its sub-classes were correlated with seizure severity. In addition, a significant correlation was not observed between serum AED level and QoL. However, medication adherence was significantly correlated with QoL (β = 0.30, p < 0.0001). The mediating effects of medication adherence on the association between serum AED level (Z = 3.39, p < 0.001) and seizure severity (Z = -3.47, p < 0.001) with QoL were supported by the Sobel test. Conclusion. This study demonstrates that medication adherence has a beneficial impact on QoL in elderly epileptics. Therefore, adherence to treatment should be monitored to improve their QoL

Multitask Deep Learning for Accurate Risk Stratification and Prediction of Next Steps for Coronary CT Angiography Patients

Diagnostic investigation has an important role in risk stratification and clinical decision making of patients with suspected and documented Coronary Artery Disease (CAD). However, the majority of existing tools are primarily focused on the selection of gatekeeper tests, whereas only a handful of systems contain information regarding the downstream testing or treatment. We propose a multi-task deep learning model to support risk stratification and down-stream test selection for patients undergoing Coronary Computed Tomography Angiography (CCTA). The analysis included 14,021 patients who underwent CCTA between 2006 and 2017. Our novel multitask deep learning framework extends the state-of-the art Perceiver model to deal with real-world CCTA report data. Our model achieved an Area Under the receiver operating characteristic Curve (AUC) of 0.76 in CAD risk stratification, and 0.72 AUC in predicting downstream tests. Our proposed deep learning model can accurately estimate the likelihood of CAD and provide recommended downstream tests based on prior CCTA data. In clinical practice, the utilization of such an approach could bring a paradigm shift in risk stratification and downstream management. Despite significant progress using deep learning models for tabular data, they do not outperform gradient boosting decision trees, and further research is required in this area. However, neural networks appear to benefit more readily from multi-task learning than tree-based models. This could offset the shortcomings of using single task learning approach when working with tabular data

Seroepidemiological Study of Human Hydatidosis in Meshkinshahr District, Ardabil Province, Iran

Background: The aim of this study was to conduct a sero-epidemiological survey in Meshkinshahr, Arda­bil Province, northwestern Iran to detect the rate of hydatidosis in the city and nearby villages. Literature shows that no such study has been conducted so far.Methods: Overall, 670 serum samples were collected from 194 males and 476 females from patients re­ferred to different health centers of the region. All patients filled out a questionnaire and an informed con­sent. Sera were analyzed using indirect-ELISA test. Ten μg /ml antigens (Antigen B derived from hydatid cyst fluid), serum dilutions of 1:500 and conjugate anti-human coombs with 1:10000 dilutions were util­ized to perform the test. Data analysis was conducted using SPSS software ver. 11.5. Results: The seroprevalence of human hydatidosis was 1.79% by ELISA test in the region. This rate for fe­males was 1.68% and males 2.6%, respectively. There was no significant difference as regards all fac­tors studied and the seropositivity. According to job, farmers and ranchmen had the highest rate of infec­tion as 3.17%. The sero-prevalence of infection was 2.6%% in illiterate people which showed the highest rate. As regards residency, urban life showed no significant difference with rural life (1.1% vs. 2.58%). Age group of 69-90 yr old, with 4.62% as prevalence had the highest rate of positivity.Conclusion: Obtained sero-prevalence of hydatidosis shows more or less a resemblance to other cities of Iran, although due to the specific condition of the city we expected more rate of sero-positivity

Reliability and validity of the persian version of compulsive eating scale (CES) in overweight or obese women and its relationship with some body composition and dietary intake variables

Objective: Compulsive or binge eating is a kind of disturbed eating behavior, which is mostly observed among dieting women, and is integrated with appetite disorder, and uncontrolled eating of plenty of junk food. The Compulsive Eating Scale (CES) created first by Kagan & Squires in 1984, is an eight-item self-reporting instrument that is made to measure the severity of binge eating disorder. The aim of this study was to provide the reliability and validity of the Persian version of Compulsive Eating Scale (CES) among overweight and obese women in Iran. Method: One hundred and twenty six (N = 126) overweight and obese women consented to participate in this study. We estimated the anthropometric indices, including body weight, height, waist and hip circumferences, a total body fat percentage, and visceral fat level with body analyzer all in standard situations. Then, the participants completed the CES. Next, to assess concurrent validity, Beck Depression Inventory, Spielberger anxiety scale, appetite visual analogue rating scale, Food Craving questionnaire, Three-Factor Eating Questionnaire-R18, and Restraint eating visual analogue rating scale were performed simultaneously. To assess test-retest reliability, CES was repeated for all the participants two weeks later. Moreover, we reported the internal consistency and factor analysis of this questionnaire. Furthermore, we estimated the concurrent correlation of CES with logically relevant questionnaires and body composition and anthropometric indices. Results: Based on the reliability analysis and factor analysis of the principal component by Varimax rotation, we extracted two factors: eating because of negative feelings, and overeating. Internal consistency (Cronbach's alpha) of the CES was 0.85 (Cronbach alpha of the factors was 0.85, and 0.74, respectively). The test-retest correlation of the CES was 0.89. Also, the split-half reliability of the questionnaire was established with the correlation coefficient between Sets I and II. The correlation was 0.85. Conclusion: This study provides preliminary support for the reliability and validity of the Persian version of the CES. This instrument would be helpful in measuring the clinical practice and research studies of obesity, appetite and eating disorders reliably and validly

International Consensus on Differential Diagnosis and Management of Patients With Danon Disease: JACC State-of-the-Art Review

Danon disease is a rare X-linked autophagic vacuolar cardioskeletal myopathy associated with severe heart failure that can be accompanied with extracardiac neurologic, skeletal, and ophthalmologic manifestations. It is caused by loss of function variants in the LAMP2 gene and is among the most severe and penetrant of the genetic cardiomyopathies. Most patients with Danon disease will experience symptomatic heart failure. Male individuals generally present earlier than women and die of either heart failure or arrhythmia or receive a heart transplant by the third decade of life. Herein, the authors review the differential diagnosis of Danon disease, diagnostic criteria, natural history, management recommendations, and recent advances in treatment of this increasingly recognized and extremely morbid cardiomyopathy

Extra virgin olive oil in maternal diet in, but high amount has deleterious effects creases osteogenic genes expression on bones in mice offspring at adolescence

Objective(s): Maternal high-fat diet has been shown to have deleterious effects on the offspring bones. However, there is no study to assess the effects of type and amount of maternal dietary oil in an isocaloric diet, with focus on extra virgin olive oil (EVOO). The objective of the current study was to test the hypothesis that type of maternal dietary oil has more effects than its amount in an isocaloric diet during gestation and lactation on bone genes expression in offspring in adolescence. Materials and Methods: Virgin female C57BL/6 mice were impregnated and fed either the AIN 93G diet (received 16 of calories as soybean oil, as a control diet, or EVOO) or a high fat AIN 93G diet (received 45 of calories as soybean oil or EVOO) from the time of vaginal plug confirmation until offspring�s weaning. Results: After adjusting for the amount of oils, osteoprotegerin/ receptor activator of nuclear factor NF-κB ligand (OPG/RANK-L) and OPG expressions were 6.1-and 2.8-folds higher in offspring born to EVOO compared with soybean oil-fed mothers. OPG, beta-catenin, and OPG/RANK-L expression were 88, 94, and 70 lower in offspring born to the 45 oil-fed mothers compared with the 16 group. In contrast, peroxisome proliferator-activated receptor gamma-2 (PPARγ2) gene expression was higher in the 45 oil group, adjusted for the types of oil. Conclusion: Maternal EVOO consumption, but not soybean oil increased osteoblastic gene expression, and high amounts of both oils decreased osteoblastic and increased adipogenic genes expression in adolescent offspring. � 2016, Mashhad University of Medical Sciences. All rights reserved

Adaptive Synaptic Memory via Lithium Ion Modulation in RRAM Devices

Biologically plausible computing systems require fine- grain tuning of analog synaptic characteristics. In this study, lithium- doped silicate resistive random access memory with a titanium nitride (TiN) electrode mimicking biological synapses is demonstrated. Biological plausibility of this RRAM device is thought to occur due to the low ionization energy of lithium ions, which enables controllable forming and filamentary retraction spontaneously or under an applied voltage. The TiN electrode can effectively store lithium ions, a principle widely adopted from battery construction, and allows state- dependent decay to be reliably achieved. As a result, this device offers multi- bit functionality and synaptic plasticity for simulating various strengths in neuronal connections. Both short- term memory and long- term memory are emulated across dynamical timescales. Spike- timing- dependent plasticity and paired- pulse facilitation are also demonstrated. These mechanisms are capable of self- pruning to generate efficient neural networks. Time- dependent resistance decay is observed for different conductance values, which mimics both biological and artificial memory pruning and conforms to the trend of the biological brain that prunes weak synaptic connections. By faithfully emulating learning rules that exist in human’s higher cortical areas from STDP to synaptic pruning, the device has the capacity to drive forward the development of highly efficient neuromorphic computing systems.In this study, lithium- doped silicate resistive random access memory with a titanium nitride (TiN) electrode is shown to mimic biological synapses. The TiN electrode effectively stores lithium ions, a principle widely adopted from battery construction, and enables reliable state- dependent decay. This device offers multi- bit functionality and synaptic plasticity, short- term memory and long- term memory, spike- timing- dependent plasticity and paired- pulse facilitation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163426/3/smll202003964-sup-0001-SuppMat.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163426/2/smll202003964_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163426/1/smll202003964.pd

European guideline on obesity care in patients with gastrointestinal and liver diseases - Joint ESPEN/UEG guideline

BACKGROUND: Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence. OBJECTIVE: The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity. METHODS: The present guideline was developed according to the standard operating procedure for ESPEN guidelines, following the Scottish Intercollegiate Guidelines Network (SIGN) grading system (A, B, 0, and good practice point (GPP)). The procedure included an online voting (Delphi) and a final consensus conference. RESULTS: In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician. CONCLUSION: The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice