Cannabis and breastfeeding

Abstract Introduction Smartphone applications for health (M-Health) seem to overcome barriers to access Cardiovascular Rehabilitation Programs (CRP), because of their high degree of acceptance and also their potential to influence the frequency of physical exercise in weight loss. Objective To analyze the effectiveness of the combination of M-Health and CRP compared to CRP alone on functional capacity, adherence to CRP, management of cardiovascular risk factors in cardiac patients. Design Systematic Review and Meta-Analysis. Methods The following databases were used Medline via Ovid, EMBASE, Central, PEDro and SPORTDiscus via EBSCOhost from their inception until July/2020. We included randomized controlled trials investigating the effects of M-Health in combination with CRP compared to CRP alone in adults with heart disease, and the interventions with M-Health consisted of text messages, e-mails, and applications. The primary outcome of this review was functional capacity, measured by VO2peak, or self-reported physical activity (METs.min/week). PEDro scale was used to assess the methodological quality of the studies and the GRADE approach to assess the overall quality of evidence. Pooled estimates were calculated using a random effect model to obtain mean difference (MD) or standardized mean differences (SMD) and their respectives 95% confidence intervals (CI). Results Nineteen RCTs were eligible, the median risk of bias was 7 out of 10 points. The primary endpoint was analyzed by subgroups, time of intervention and kind of type CRP, eigthteen of these studies assessed functional capacity. CRP in combination with a m-health intervention was more effective than CRP alone in improving VO2peak, ml/min/kg, (MD: 0.84, CI: 0.30 to 1.38; I2=0%, high quality evidence, 12 trials, n=1889) at short-term follow-up, but at medium-term follow-up (MD: 0.84, CI: −0.26 to 1.41; I2=0%, high quality evidence, 8 trials, n=927,). Similarly, CRP associated with m-health was superior to CRP alone in increasing self-reported at short-term, METs.min/week, (MD:1.31, CI: −0.24 to 2.37; I2 = not aplicable, very low quality evidence, 1 trial, n=18), and at medium-term follow-up (MD: 0.18, CI: −0.01 to 0.36; I2=56%, moderate quality evidence, 4 trials, n=1107). Conclusion High quality of evidence shows that M-Health improves cardiorespiratory fitness at short-term follow-up. In addition, supervised program showed to be more effective than non-supervised. Funding Acknowledgement Type of funding sources: None.

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Antimicrobial prescribing for hospital-acquired pneumonia

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.0325 ◽

2020 ◽

Vol 81 (1) ◽

pp. 1-3

Author(s):

Tim Felton ◽

Dan Wootton

Keyword(s):

Decision Making ◽

Antibiotic Prescribing ◽

High Quality ◽

Antimicrobial Prescribing ◽

High Quality Evidence ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired ◽

The Impact ◽

Inform Decision Making ◽

Quality Evidence

The impact of hospital-acquired pneumonia and the pressure to reduce unnecessary antibiotic prescribing has lead to the publication of prescribing guidelines from the National Institute for Health and Care Excellence. This editorial gives an overview of the guidelines and emphasises the need for more high-quality evidence to inform decision making in this group of patients.

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Impact of Social Restriction Imposed by 2019-ncov Pandemic on the Mobility of Older People: A Scope Review Protocol

10.21203/rs.3.rs-88174/v1 ◽

2020 ◽

Author(s):

Sarah Bandeira ◽

Patricia Batista ◽

Cristina Cristóvão Ribeiro Silva ◽

Ruth Caldeira Melo ◽

Monica Rodrigues Perracini

Keyword(s):

Older People ◽

Latin American ◽

Health Care Providers ◽

Adverse Outcomes ◽

Care Providers ◽

Targeted Interventions ◽

Thomson Reuters ◽

Social Restriction ◽

The Impact ◽

At Home

Abstract Background The 2019‑nCoV pandemic represents a high risk for older people that sustain higher mortality rates compared to young adults. Limited social contact and restriction of mobility in the community (stay-at-home precautions) are recognised as measures to prevent SARS-CoV-2 infection among older people. The impact of these measures on health, physical function and emotional wellbeing are numerous, and might result in long-term adverse outcomes such as disability, falls and limited mobility. Thus, the objective of this scope review is to map the estimated impact of measures of social restrictions on the mobility of older people living in the community and to systematize the existing recommendations, anticipating possible intervention strategies gaps.Methods The search will be carried out using a standardized protocol in Latin American and Caribbean Literature on Health Sciences (LILACS), consulted by the Virtual Health Library (VHL), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), via PubMed; Web of Science, via Main Collection (Thomson Reuters Scientific) and SCOPUS. Documents and reports with recommendations from governmental and nongovernmental organizations will be consulted. Complete studies available in the English, Spanish or Portuguese languages included in the different methodological approaches (original articles, literature reviews, editorials and guidelines) that necessarily address the recommendations of social restriction measures for preventing Covid-19 disease and their impacts on mobility of older people will be included. Two reviewers will select the studies based on their titles and abstracts. The manuscripts and documents selected for full reading will be analysed by reviewers concerning the eligibility criteria. When disagreements occurred in any phase of the selection process, a third reviewer will be included for a consensus analysis. Data will be extracted using a template form and the PRISMA-ScR checklist will be used to guarantee quality and transparency. Results will be presented as a narrative summary, including tables and figures.Discussion Globally, recommendations to stay-at-home and social distancing are substantially affecting health and wellbeing of older people. Preserving mobility is crucial to active and healthy ageing. The evidence summarized in the selected studies will be analysed in order to answer the research questions. The results of this review will help clinical practitioners, health care providers and policy makers to estimate the impact of measures to protect older people from 2019‑nCoV and to identify gaps and anticipate needs for targeted interventions to prevent mobility decline. Systematic review registrationsubmitted on 10-09-2020 in https://osf.io/registries

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Group physiotherapy with survivors of torture in urban and camp settings in Jordan and Kenya

Torture Journal ◽

10.7146/torture.v30i3.121785 ◽

2021 ◽

Vol 30 (3) ◽

pp. 27-42

Author(s):

Laura Janet Pizer Gueron ◽

Arobogust Amoyi ◽

Winnie Chao ◽

Justine Chepngetich ◽

Jepkemoi Joanne Kibet ◽

...

Keyword(s):

Health Care Providers ◽

Group Treatment ◽

Community Education ◽

Pelvic Floor Dysfunction ◽

Interdisciplinary Treatment ◽

Care Providers ◽

Biopsychosocial Perspective ◽

Clinically Significant ◽

The Impact

Introduction: In this paper we report provisional field results on the impact of CVT’s (the Center for Victims of Torture) interdisciplinary group treatment on physiotherapy indicators in refugees living in urban and camp settings in Kenya and Jordan. The physiotherapy component of this model includes pain neuroscience education, sleep hygiene, posture and body mechanics instruction and healing of pain and trauma from a biopsychosocial perspective, in a program of ten weekly sessions. This program is supported by a clinical assessment that records a broad set of indicators of participant experience and functioning. In addition, some survivors report having pelvic floor dysfunction and data will be offered about a subset of survivors looking at prevalence of these issues. Methods: Survivors are identified through referral systems, community education and sensitization campaigns, contacts and trainings with other NGOs and health care providers. Prospective survivors are screened into CVT services or referred to other agencies that can better meet their needs. CVT focuses its services on refugees with physical and emotional difficulties that may be effectively treated through its interdisciplinary treatment model and who have survived torture or related human rights violations. Following an informed consent process, survivors participate in a comprehensive individual assessment and then progress to the 10-week program. Wherever possible, follow-up assessments are conducted 2 weeks after the sessions end, and at 3, and 9 months following completion of the 10-week long intervention. Results: On average, participants who completed 3-month follow-up assessments showed statistically and clinically significant improvements on physiotherapy indicators. Discussion: Provisional results are encouraging and suggest that the model is adaptable to the needs of different populations and settings. As nearly all participants receive both counseling and physiotherapy, it is difficult to know which benefits can be attributed to physiotherapy alone.

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Chromosome 17: neXt-MP50 C-HPP Challenge Completed

10.1101/734657 ◽

2019 ◽

Author(s):

Hongjiu Zhang ◽

Omer Siddiqui ◽

Yuanfang Guan ◽

Gilbert S. Omenn

Keyword(s):

Protein Interaction ◽

Protein Level ◽

Chromosome 17 ◽

Protein Interaction Data ◽

Interaction Data ◽

High Quality ◽

Protein Protein Interaction ◽

High Quality Evidence ◽

Quality Evidence

ABSTRACTThe C-HPP Team for Chromosome 17 has documented meeting the neXt-MP50 Missing Protein Challenge. Protein-level PE1 evidence including MS and protein-protein interaction data from the global proteomics community has reduced the number of PE2,3,4 proteins coded on Chromosome 17 by 50 since the 2016 baseline in neXtProt. As a follow-up to our analysis and prioritization of Chr 17 missing proteins last year, we describe what predictions and guidance were successful in this update and we explain the dynamics of a net reduction of PE2,3,4 Missing Proteins. This analysis can serve as a guide for other C-HPP chromosome teams seeking high-quality evidence for the 2129 remaining missing proteins.

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Conservative Management of Acute Appendicitis In The Era Of COVID 19: A Multicenter prospective observational study at The United Arab Emirates

10.1101/2020.09.30.20204503 ◽

2020 ◽

Author(s):

Fatima Y. AL Hashmi ◽

Abeer Al Zuabi ◽

Ibrahim Y. Hachim ◽

Guido H.H. Mannaerts ◽

Omar Bekdache

Keyword(s):

Health Care ◽

Acute Appendicitis ◽

United Arab Emirates ◽

Health Care Providers ◽

Conservative Management ◽

Length Of Hospital Stay ◽

Operative Management ◽

Care Providers ◽

The Impact

Background Since its emergence in December 2019, the Novel Coronavirus (COVID-19) pandemic resulted in a profound impact on the health care system worldwide. We propose herein to evaluate the impact of implementing conservative management as an alternative approach to surgical appendectomy in the treatment of proven acute appendicitis during COVID19 pandemic. Methods Our study is a prospective multicenter study that includes a cohort of 160 patients admitted to the surgical departments in both Tawam Hospital and Sheikh Shakhbout Medical City, Abu Dhabi, UAE, for the period from February 2020 till July 2020. Results Our results showed that 56 of our patients (35%) were treated conservatively, while the other 104 (65%) underwent operative management. There was a significant decrease in length of hospital stay (LOS) (2.32 days) among the first group compared to the second (2.8 days). Also, short term follow-up showed that 90% of those patients did not require further operative intervention or developed any serious complications. Out of the 110 patients that were swapped for COVID19, nine (8.18%) were confirmed to be positive. Our protocol was to avoid surgical management for COVID19 positive patients unless indicated. This resulted in (8/9) of COVID19 positive patients to be treated conservatively. Follow up was achieved by using telemedicine-based follow-up with the aim of empowering social distancing and reducing risk of viral exposure to patients as well as the health care providers. In conclusion, our results showed that the implementation of conservative management in treating patients with acute appendicitis who were COVID19 positive is a safe and feasible approach that maybe essential in reducing viral transmission risks as well as avoiding operative risks on COVID19 positive patients.

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The Impact of Physical Activity (PA) on the Prevention of Type 2 Diabetes; Evidence and Lessons Learned from the Diabetes Prevention Program (DPP), a Long-Standing Clinical Trial Incorporating Subjective and Objective Activity Measures

10.2337/figshare.13103333.v1 ◽

2020 ◽

Author(s):

Andrea M. Kriska ◽

Bonny Rockette-Wagner ◽

Sharon L. Edelstein ◽

George A. Bray ◽

Linda M. Delahanty ◽

...

Keyword(s):

Health Care Providers ◽

Diabetes Prevention ◽

Cox Proportional Hazards ◽

Lessons Learned ◽

Diabetes Incidence ◽

Care Providers ◽

Cross Sectional ◽

Entire Cohort ◽

The Impact

Objective: Across the DPP follow-up, cumulative diabetes incidence remained lower in the lifestyle compared to placebo and metformin randomized groups and could not be explained by weight. Collection of self-reported PA (yearly) with cross-sectional objective PA (in follow-up) allowed for examination of PA and its long-term impact on diabetes prevention. Research Design and Methods: Yearly self-reported PA and diabetes assessment, OGTT, (fasting glucose semi-annually) was collected for 3232 participants with one accelerometry assessment 11-13 years after randomization (n=1,793). Mixed models determined PA differences across treatment groups. The association between PA and diabetes incidence was examined using Cox proportional hazards models. Results: There was a 6% decrease (Cox proportional HR 0.94 [0.92, 0.96]; P< 0.001) in diabetes incidence per 6 MET-hrs/week increase in time-dependent PA for the entire cohort over an average 12 years (controlled for age, sex, baseline PA and weight). The effect of PA was greater (12% decrease) among participants less active at baseline (<7.5 MET-hrs/week) (n=1338; HR 0.88 [0.83, 0.93] P<0.0001) with stronger findings for lifestyle participants. Lifestyle had higher cumulative PA compared with metformin or placebo (p<0.0001) and higher accelerometry total minutes/day measured in follow-up (P=0.001 and 0.047). All associations remained significant with weight in the models. Conclusions: PA was inversely related to incident diabetes in the entire cohort across the study with cross-sectional accelerometry results supporting these findings. This highlights the importance of PA within lifestyle intervention efforts designed to prevent diabetes and urge health-care providers to consider both PA and weight when counseling high-risk patients.

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From common sense to evidence-based: An evaluation of survivorship planning.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.76 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 76-76

Author(s):

Sam Gaster

Keyword(s):

Health Care ◽

Cancer Survivors ◽

Health Care Providers ◽

Common Sense ◽

Care Providers ◽

Care Plans ◽

Follow Up Care ◽

The Future ◽

The Impact

76 Background: The Institute of Medicine’s (IOM; 2005) seminal report, From Cancer Patient to Cancer Survivor: Lost in Transition, recommended survivorship care plans (SCPs) as a common sense approach to improve the care of cancer survivors. The American Society of Clinical Oncology (ASCO; Mayer et al., 2014) reiterated the importance of these plans and provided strategic guidance for their implementation. The American College of Surgeons’ Commission on Cancer requires SCP delivery from accredited cancer programs as of 2015. Despite the push from these organizations, SCPs remain understudied (Mayer, Birken, Check, & Chen, 2014). The impact of SCPs on patient outcomes is poorly understood. Additionally, there is limited data on patients’ preferences for SCPs. This evaluation describes the use and assessment of SCPs at six regional cancer centers in the Midwest. Methods: Feedback was collected from 30 cancer survivors after receipt of a SCP. Responses were collected with 22-item questionnaire. Outcomes included survivors’ satisfaction with the clarity and detail of SCPs, likelihood to use SCPs in the future, intention to share SCPs with other health care providers, and perceived knowledge about treatment and follow-up care. Results: Over 75% (n = 23) of survivors agreed that SCPs were easy to understand. Ninety-three percent (n = 28) of survivors indicated that SCPs contained the right amount of information. Fifty-three percent (n = 16) of survivors are very likely to use their SCP in the future, whereas 47% (n = 14) are somewhat likely to use their SCP in the future. The majority (77%; n = 23) of survivors intend to share their SCP with another health care provider. Ninety-seven percent (n = 29) of survivors felt more knowledge about their treatment and follow-up car as a result of receiving a SCP. Conclusions: This evaluation highlights the many benefits of SCPs for cancer survivors. Results suggest that SCPs educate survivors about their treatment and follow-up care. Additionally, results indicate that many survivors intend to share SCPs, perhaps allowing for better coordination between oncology and primary care. Further research is warranted on the adoption of healthy lifestyle behaviors and receipt of routine health care after delivery of SCPs.

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The Impact of Physical Activity (PA) on the Prevention of Type 2 Diabetes; Evidence and Lessons Learned from the Diabetes Prevention Program (DPP), a Long-Standing Clinical Trial Incorporating Subjective and Objective Activity Measures

10.2337/figshare.13103333 ◽

2020 ◽

Author(s):

Andrea M. Kriska ◽

Bonny Rockette-Wagner ◽

Sharon L. Edelstein ◽

George A. Bray ◽

Linda M. Delahanty ◽

...

Keyword(s):

Health Care Providers ◽

Diabetes Prevention ◽

Cox Proportional Hazards ◽

Lessons Learned ◽

Diabetes Incidence ◽

Care Providers ◽

Cross Sectional ◽

Entire Cohort ◽

The Impact

Objective: Across the DPP follow-up, cumulative diabetes incidence remained lower in the lifestyle compared to placebo and metformin randomized groups and could not be explained by weight. Collection of self-reported PA (yearly) with cross-sectional objective PA (in follow-up) allowed for examination of PA and its long-term impact on diabetes prevention. Research Design and Methods: Yearly self-reported PA and diabetes assessment, OGTT, (fasting glucose semi-annually) was collected for 3232 participants with one accelerometry assessment 11-13 years after randomization (n=1,793). Mixed models determined PA differences across treatment groups. The association between PA and diabetes incidence was examined using Cox proportional hazards models. Results: There was a 6% decrease (Cox proportional HR 0.94 [0.92, 0.96]; P< 0.001) in diabetes incidence per 6 MET-hrs/week increase in time-dependent PA for the entire cohort over an average 12 years (controlled for age, sex, baseline PA and weight). The effect of PA was greater (12% decrease) among participants less active at baseline (<7.5 MET-hrs/week) (n=1338; HR 0.88 [0.83, 0.93] P<0.0001) with stronger findings for lifestyle participants. Lifestyle had higher cumulative PA compared with metformin or placebo (p<0.0001) and higher accelerometry total minutes/day measured in follow-up (P=0.001 and 0.047). All associations remained significant with weight in the models. Conclusions: PA was inversely related to incident diabetes in the entire cohort across the study with cross-sectional accelerometry results supporting these findings. This highlights the importance of PA within lifestyle intervention efforts designed to prevent diabetes and urge health-care providers to consider both PA and weight when counseling high-risk patients.

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Recent advances in transfusions in neonates/infants

F1000Research ◽

10.12688/f1000research.13979.1 ◽

2018 ◽

Vol 7 ◽

pp. 609 ◽

Cited By ~ 10

Author(s):

Ruchika Goel ◽

Cassandra D. Josephson

Keyword(s):

Evidence Base ◽

Adverse Outcomes ◽

Phase Iii ◽

Current Evidence ◽

Current Phase ◽

Blood Component ◽

Research Knowledge ◽

High Quality ◽

High Quality Evidence ◽

Quality Evidence

Transfusions of red blood cells (RBCs), platelets, and plasma are critical therapies for infants and neonates (particularly preterm neonates) in the neonatal intensive care unit, who are the most frequently transfused subpopulation across all ages. Although traditionally a significant gap has existed between the blood utilization and the evidence base essential to adequately guide transfusion practices in infants and neonates, pediatric transfusion medicine is evolving from infancy and gradually coming of age. It is entering an exciting era with recognition as an independent discipline, a new and evolving high-quality evidence base for transfusion practices, novel technologies and therapeutics, and national/international collaborative research, educational, and clinical efforts. Triggers and thresholds for red cell transfusion are accumulating evidence with current phase III clinical trials. Ongoing trials and studies of platelet and plasma transfusions in neonates are anticipated to provide high-quality evidence in years to come. This article aims to summarize the most current evidence-based practices regarding blood component therapy in neonates. Data on the use of specific components (RBCs, plasma, and platelets) are provided. We attempt to define thresholds for anemia, thrombocytopenia, and abnormal coagulation profile in neonates to highlight the difficulties in having a specific cutoff value in neonates and preterm infants. Indications for transfusion of specific products, transfusion thresholds, and current practices and guidelines are provided, and possible adverse outcomes and complications are discussed. Finally, the critical research knowledge gaps in these practices as well as ongoing and future research areas are discussed. In an era of personalized medicine, neonatal transfusion decisions guided by a strong evidence base must be the overarching goal, and this underlies all of the strategic initiatives in pediatric and neonatal transfusion research highlighted in this article.

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