7 research outputs found
Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed
Oral versus written feedback delivery to nursing students in clinical education: A randomized controlled trial
Background: Feedback delivery is deemed as a key element during a students' clinical education. It keeps
students on track to meet their goal and increase students' motivation and confidence.
Objective: The aim of this study was to compare the quality of feedback delivery in oral versus written feedback
delivery to nursing students in clinical education.
Methods: A randomized controlled trial was conducted between February and August 2012 in the city of
Bojnurd in Iran. Using purposive sampling, last semester’s nursing students (n=44) had been randomly assigned
to oral and written feedback delivery groups. Three Instructors received orientation and training on methods of
feedback delivery before study initiation. Then, they gave necessary oral and written feedback to the students.
Clinical settings of the study included coronary care, surgical, and neonatal units of hospitals. Data collection
tools were quality of feedback delivery, students' satisfaction questionnaire and students' reactions checklist. Data
were analyzed using SPSS version 11.5 with chi-square test and the t-test.
Results: Most of the students (52%, n=23) were male. There were no significant differences between the scores
of quality of oral and written feedback delivery (p>0.05). The study did not show a difference of satisfaction level
between the oral and written feedback groups. The relationship between students' reactions and feedback type at
the confidence level of 90% was significant, so that students who received oral feedback showed more severe
reactions as compared to the written feedback group.
Conclusion: According to the results, the type of feedback is not an important factor in clinical education quality
and satisfaction level. They may achieve a better outcome by focusing on the other aspects of quality of feedback
delivery rather than feedback type.
Trial registration: The trial was registered at the Iranian Registration Center for Clinical Trials with the Irct id:
(IRCT: 201111128076N1).
Funding: North Khorasan University of Medical Sciences (permission no. 89/p/209)
A New Method for Extubation: Comparison between Conventional and New Methods
Background: Extubation is associated with the risk of complications such as accumulated secretion above the endotracheal tube cuff, eventual atelectasia following a reduction in pulmonary volumes because of a lack of physiological positive end expiratory pressure, and intra-tracheal suction. In order to reduce these complications, and, based on basic physiological principles, a new practical extubation method is presented in this article.
Methods: The study was designed as a six-month prospective cross-sectional clinical trial. Two hundred fifty-seven patients undergoing coronary artery bypass grafting (CABG) were divided into two groups based on their scheduled surgery time. The first group underwent the conventional extubation method, while the other group was extubated according to a new described method. Arterial blood gas (ABG) analysis results before and after extubation were compared between the two groups to find the effect of the extubation method on the ABG parameters and the oxygenation profile.
Results: In all time intervals, the partial pressure of oxygen in arterial blood / fraction of inspired oxygen(PaO/ FiO ) ratio in the new method group patients was improved compared to that in the conventional method; some differences, like PaO\FiO four hours after extubation, were statistically significant, however (p value = 0.0063).
Conclusion: The new extubation method improved somerespiratory parameters and thus attenuated oxygenationcomplications and amplified oxygenation after extubation
Clocks on top: The role of the circadian clock in the hypothalamic and pituitary regulation of endocrine physiology
Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019Research in context
Summary: Background: The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods: We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings: In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation: The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding: The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38)