Induction versus expectant monitoring for intrauterine growth restriction at term: Randomised equivalence trial (DIGITAT)

Objective: To compare the effect of induction of labour with a policy of expectant monitoring for intrauterine growth restriction near term. Design: Multicentre randomised equivalence trial (the Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT)). Setting: Eight academic and 44 non-academic hospitals in the Netherlands between November 2004 and November 2008. Participants: Pregnant women who had a singleton pregnancy beyond 36+0 weeks' g

The protocol-guided rapid evaluation of veterans experiencing new transient neurological symptoms (PREVENT) quality improvement program: rationale and methods

Abstract Background Transient ischemic attack (TIA) patients are at high risk of recurrent vascular events; timely management can reduce that risk by 70%. The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) developed, implemented, and evaluated a TIA quality improvement (QI) intervention aligned with Learning Healthcare System principles. Methods This stepped-wedge trial developed, implemented and evaluated a provider-facing, multi-component intervention to improve TIA care at six facilities. The unit of analysis was the medical center. The intervention was developed based on benchmarking data, staff interviews, literature, and electronic quality measures and included: performance data, clinical protocols, professional education, electronic health record tools, and QI support. The effectiveness outcome was the without-fail rate: the proportion of patients who receive all processes of care for which they are eligible among seven processes. The implementation outcomes were the number of implementation activities completed and final team organization level. The intervention effects on the without-fail rate were analyzed using generalized mixed-effects models with multilevel hierarchical random effects. Mixed methods were used to assess implementation, user satisfaction, and sustainability. Discussion PREVENT advanced three aspects of a Learning Healthcare System. Learning from Data: teams examined and interacted with their performance data to explore hypotheses, plan QI activities, and evaluate change over time. Learning from Each Other: Teams participated in monthly virtual collaborative calls. Sharing Best Practices: Teams shared tools and best practices. The approach used to design and implement PREVENT may be generalizable to other clinical conditions where time-sensitive care spans clinical settings and medical disciplines. Trial registration clinicaltrials.gov: NCT02769338 [May 11, 2016].https://deepblue.lib.umich.edu/bitstream/2027.42/152210/1/12883_2019_Article_1517.pd

The Role of Human Immunodeficiency Virus-Associated Vasculopathy in the Etiology of Stroke

Background: Human immunodeficiency virus (HIV) infection is a recognized risk factor for stroke among young populations, but the exact mechanisms are poorly understood. We studied the clinical, radiologic, and histologic features of HIV-related ischemic stroke to gain insight into the disease mechanisms. Methods: We conducted a prospective, in-depth analysis of adult ischemic stroke patients presenting to Queen Elizabeth Central Hospital, Blantyre, Malawi, in 2011. Results: We recruited 64 HIV-infected and 107 HIV-uninfected patients. Those with HIV were significantly younger (P < .001) and less likely to have established vascular risk factors. Patients with HIV were more likely to have large artery disease (21% vs 10%; P < .001). The commonest etiology was HIV-associated vasculopathy (24 [38%]), followed by opportunistic infections (16 [25%]). Sixteen of 64 (25%) had a stroke soon after starting antiretroviral therapy (ART), suggesting an immune reconstitution-like syndrome. In this group, CD4+ T-lymphocyte count was low, despite a significantly lower HIV viral load in those recently started on treatment (P < .001). Conclusions: HIV-associated vasculopathy and opportunistic infections are common causes of HIV-related ischemic stroke. Furthermore, subtypes of HIV-associated vasculopathy may manifest as a result of an immune reconstitution-like syndrome after starting ART. A better understanding of this mechanism may point toward new treatments

Level of awareness of primagravida mothers regarding foeniculum vulgare (anis) as herbal medicine in selected barangays in Imus City, Cavite

This study utilized a non-experimental, descriptive research design. This study involved 100 respondents, breastfeeding mothers from selected barangays in Imus City, Cavite which includes Medicion I, Medicion II, Malagasang I, Bucandala 2, and Bucandala 3. The respondents were chosen using judgemental sampling. It utilized a self-made questionnaire entitled “Level of Awareness of Primigravida Mothers regarding Foeniculum Vulgare (Anis) as Herbal Medicine.” The questions were formulated based on the literature of the study. Data was analysed using mean, t-test, Analysis of Variance (ANOVA), frequency, and percentage. The following conclusions were drawn: (1) most of the primigravida mothers were 18 to 24 years old, have a college degree, have a monthly income of Php10,000.00 and below, and profess Catholic faith; (2) the primigravida mothers were aware on foeniculumvulgare (anis) as herbal medicine to a least extent; (3) the level of awareness of the primigravida mothers on foeniculum vulgare (anis) as herbal medicine was the same regardless of their age, educational attainment, monthly family income, and religious affiliation