Effects and Safety of Allisartan Isoproxil Combined With Amlodipine or Indapamide in Patients With Hypertension Who Failed Allisartan Monotherapy

Background To primarily evaluate the effects and safety of a selective angiotensin II type 1 (AT1) receptor blocker (ARB) allisartan isoproxil combined with amlodipine or indapamide in the treatment of patients with essential hypertension who failed allisartan monotherapy. Methods Patients aged 18–75 years with mild-to-moderate essential hypertension [office systolic blood pressure (SBP) 140 to <180 and/or office diastolic blood pressure (DBP) 90 to <110 mm Hg] in 44 study centers between 2016 and 2018 were recruited. Allisartan isoproxil tablet 240 mg was administered per day for 4 weeks, and continued for 8 weeks if office blood pressure (BP) achieved the target of SBP/DBP <140/90 mm Hg. The nonachievers were 1:1 randomly divided into allisartan isoproxil 240 mg + indapamide sustained-release tablet 1.5 mg, or allisartan isoproxil 240 mg + amlodipine besylate 5 mg groups for further 8 weeks of combined therapy. The BP target achieving rate, reduction of sitting BP from baseline, safety and compliance were evaluated as the primary efficacy endpoint. Results A total of 2,212 patients were enrolled, among them 2,126 patients were included in the efficacy analysis, with an average age of 55.1 ± 10.2 years. A total of 1,463 cases (68.8%) were effective after 4 weeks allisartan treatment, and the mean SBP and DBP were significantly decreased by 14.7 ± 12.2 and 8.0 ± 8.4 mm Hg compared with the baseline levels (all P < 0.001). In nonachievers, allisartan combined with indapamide for 8 weeks significantly lowered the sitting BP (SBP/DBP) by 14.0 ± 12.2/8.3 ± 9.2 mm Hg, respectively, compared with 4 weeks monotherapy with allisartan with a BP targeting rate of 57.7% (169/293). In the allisartan + amlodipine group, the SBP/DBP were significantly decreased by (14.4 ± 12.1/8.2 ± 8.2) mm Hg, respectively, with a BP targeting rate of 62.8% (181/288). There was no statistical significance in BP reduction, targeting rate, or adverse reactions between the 2 combined therapies. Conclusions Allisartan isoproxil combined with indapamide or amlodipine can further improve the BP targeting rate when allisartan monotherapy failed in essential hypertension. The 2 combined therapies have similar efficacy and safety.

ANALISIS SELF EFFICACY PERAWAT BERDASARKAN DATA DEMOGRAFI DI TENGAH PANDEMI COVID-19

Abstrak COVID-19 telah menyebabkan krisis kesehatan global dengan meningkatnya jumlah orang yang terinfeksi dan meninggal setiap hari. Melihat banyaknya kasus dan gejala pasien covid-19 diatas memberi gambaran bahwa betapa banyaknya pasien dan resiko yang harus dihadapi oleh perawat, hal ini mempengarui psikologi perawat secara umum dan terkhusus mempengaruhi efficacy diri perawat tersebut. Tujuan penelitian ini adalah menganalisis self efficacy perawat berdasarkan data demografi ditengah pandemi covid-19. Penelitian ini bersifat deskripsi analitik dengan menggunakan pendekatan kuantitatif di RSUD Pare pada bulan april – september 2021. Populasi penelitian adalah semua perawat RS. Kabupaten Kediri. Jumlah sampel yang diambil 181 orang, Pengambilan data dilakukan dengan lembar kuesioner yang berisi tentang self efficay. Berdasarkan data tersebut diatas menunjukkan bahwa self efficacy sedang pada umur responden 26-35 tahun (35,4%), jenis kelamin terbanyak perempuan 73,5%, tingkat pendidikan D-3 Keperawatan 69,1%, lama kerja 2-10 tahun 38,7%. Sedangkan analisis self efficacy berdasarkan data demografi ditunjukkan dengan varibel umur memiliki nilai p = 0,001 r = 0,352, jenis kelamin nilai p = 0,045 r = 0,182, pendidikan nilai p=0,513 r =0,133, lama kerja nilai p = 0,007 r = 0,297. Umur, jenis kelamin,pendidikan, dan lama kerja memberikan dukungan yang baik pada self efficacay seseorang dalam melakukan kegiatan, termasuk kondisi perawat selama pandemi covid-19, mereka mengalami perubahan self efficacy selama merawat pasien dengan covid-19. Kata kunci : Self Efficacy, Demografi, Perawat, Covid-19 Abstract COVID-19 has caused a global health crisis with the number of people getting infected and dying every day. Seeing the number of cases and symptoms of COVID-19 patients above illustrates how many patients and the risks nurses must face, this affects the psychology of nurses in general and in particular affects the nurse's self-efficacy. The purpose of this study was to analyze the self-efficacy of nurses based on demographic data amid the covid-19 pandemic. This research is an analytical description using a quantitative approach at Pare Hospital in April – September 2021. The research population is all hospital nurses. Kediri Regency. The number of samples taken was 181 people. Data was collected using a questionnaire sheet containing self-efficacy. Based on the data above, it shows that self-efficacy is moderate at the age of the respondent 26-35 years (35.4%), the most gender is female 73.5%, education level D-3 Nursing 69.1%, length of work 2-10 years 38,7%. While the self-efficacy analysis based on demographic data is indicated by the age variable having p-value = 0.001 r = 0.352, gender p = 0.045 r = 0.182, education p-value = 0.513 r = 0.133, length of work p = 0.007 r = 0.297. Age, gender, education, and length of work provide good support for a person's self-efficacy in carrying out activities, including the condition of nurses during the covid-19 pandemic, they experience changes in self-efficacy while caring for patients with covid-19. Keywords : Self Efficacy, Demographics, Nurses, Covid-19

Monitoring and Predicting Treatment Response of Extraocular Muscles in Grave's Orbitopathy by 99mTc-DTPA SPECT/CT

Objective: To investigate single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing inflammation in the extraocular muscles (EOMs) and predicting the therapeutic efficacy of periocular glucocorticoid therapy (PGT) for Grave's ophthalmopathy (GO).Materials and Methods: A total of 412 eyes from 206 patients with GO referred for 99mTc-DTPA orbital SPECT/CT were enrolled. Fourteen age- and gender-matched healthy controls (28 eyes) were included. The thickness and uptake ratio (UR) of four EOMs were derived from SPECT/CT. Eighty-six eyes from patients with GO patients received PGT. Changes in SPECT/CT parameters were evaluated between the pre- and post-treatment.Results: 195 eyes and 217 eyes were classified as active and inactive stages by clinical activity score (CAS). Values of the thickness and UR of each EOM, Tmax, and Umax were all significantly higher in the active GO than in the inactive GO and controls (p < 0.01). Among the 86 eyes (48 GO patients) included in the efficacy analysis, 56 eyes and 30 eyes were classified as responders and non-responders. Values of thicknesses and UR of each EOM, the maximum thickness (Tmax), and the maximum UR (Umax) all dropped following PGT in the responders (p < 0.01). Logistic regression analysis identified the Umax as an independent predictor for the responders (p < 0.01). Moreover, the Umax demonstrated incremental predictive value over clinical characters and CAS, as evidenced by the improved area under the curve (0.85 vs. 0.78) and global chi-square (34.12 vs. 18.1).Conclusion:99mTc-DTPA SPECT/CT has the potential to assess inflammatory activity by detecting the involvement of EOMs in GO. Pre-treatment UR provides independent and incremental values for the prediction of PGT treatment response.

Adherence to an Injury Prevention Warm-Up Program in Children’s Soccer—A Secondary Analysis of a Randomized Controlled Trial

This study examined the impact of high adherence to a neuromuscular training (NMT) warm-up on the risk of lower extremity (LE) injuries in children’s soccer. Twenty U11–U14 youth clubs (n = 92 teams, 1409 players) were randomized into intervention (n = 44 teams) and control (n = 48 teams) groups. The intervention group was advised to perform an NMT warm-up 2 to 3 times a week for 20 weeks. Team adherence, injuries, and exposure were registered throughout the follow-up. Primary outcomes were the incidence of soccer-related acute LE injuries and the prevalence of overuse LE injuries. Intervention teams conducted mean 1.7 (SD 1.0) NMT warm-ups weekly through follow-up. The seasonal trend for adherence declined significantly by −1.9% (95% CI −0.8% to −3.1%) a week. There was no difference in the incidence of acute injuries nor the prevalence of overuse LE injuries in high team adherence group (n = 17 teams) compared to controls. However, the risk for acute noncontact LE injuries was 31% lower in the high team adherence group compared to controls (IRR 0.69, 95% CI 0.49 to 0.97). In an efficacy analysis (n = 7 teams), there was a significant reduction of 47% in the rate of noncontact LE injuries (IRR 0.53, 95% CI 0.29 to 0.97). In conclusion, teams conducted NMT warm-up sessions regularly, but with a declining trend. A greater protective effect was seen in teams with the highest adherence to the NMT warm-up.

Offshore Health Innovations

Objectives/Scope Analysis of 15 years results of remote occupational health care in oil and gas production industries. Methods, Procedures, Process Continuous observation, statistical analysis of morbidity, mortality, and treatment results in industrial personnel at different endpoints depending on the variability of care models. Cost-efficacy analysis of several occupational health interventions. Targeted polls of Customers. Dynamics of new Customers. Results, Observations, Conclusions The best practices which provide the maximum efficacy include risk assessment and risk management, action planning for emergencies, telemedicine, education, registry maintenance. Each of all these gave a 10-100-fold rise in Customer satisfaction, seriously improved medical statistics. Telemedicine implies both: the delivery of highly specialized diagnostic technologies directly to the industrial production site, where a GP or paramedic is present, and it implements the direct replacement of medics with gadgets at the patient's bedside. Education involves hands-on training for both industrial personnel at remote sites and for medical professionals who provide care. The 2020-21 COVID19 pandemic was a great real stress test for remote health models when systemic integrated management procedures played a pivotal role in ensuring smooth industry operation due to the high quality of back medical services. Novel/Additive Information Modern efficient models of medical care for remote industries are necessarily comprehensive, modular, adaptive, and rely on personnel health registers. Remote health practices gain a 5-15% rise in price every year, but it pays off in greater labor productivity and in improving the health of industry personnel.

Primary COVID-19 vaccine cycle and booster doses efficacy: analysis of Italian nationwide vaccination campaign

We provide here an updated analysis of primary COVID-19 vaccination and vaccine booster doses efficacy, emerging from the ongoing Italian nationwide COVID-19 vaccination campaign. Primary COVID-19 vaccination efficacy was 76-92% within 6 months, decreasing to 34-80% after 6 months. Administration of vaccine booster doses decreased SARS-CoV-2 infections by 65%, COVID-19 related hospitalizations and deaths by 69% and 97% compared to vaccine efficacy after 6 months, but also decreased SARS-CoV-2 infections by 39% compared to vaccine efficacy within 6 months. These results suggest that COVID-19 vaccine booster doses are important for restoring vaccine efficacy and further limiting virus circulation.