Effect of Renal Denervation for the Management of Heart Rate in Patients With Hypertension: A Systematic Review and Meta-Analysis

Objective:The effect of renal denervation (RDN) on heart rate (HR) in patients with hypertension had been investigated in many studies, but the results were inconsistent. This meta-analysis was performed to evaluate the efficacy of RDN on HR control.Methods:Databases, such as PubMed, EMBASE, Cochrane, and ClinicalTrials.gov, were searched until September 2021. Randomized controlled trials (RCTs) or non-RCTs of RDN in hypertensive patients with outcome indicators, such as HR, were selected. Weighted mean difference (WMD) was calculated for evaluating the changes in HR from baseline using fixed-effects or random-effects models. The Spearman's correlation coefficients were used to identify the relationship between the changes of HR and systolic blood pressure (SBP).Results:In the current meta-analysis, 681 subjects from 16 individual studies were included. This study showed that RDN could reduce office HR in patients with hypertension [WMD = −1.93 (95% CI: −3.00 to −0.85, p < 0.001)]. In addition, 24-h HR and daytime HR were decreased after RDN [WMD = −1.73 (95% CI: −3.51 to −0.31, p = 0.017) and −2.67 (95% CI: −5.02 to −0.32, p = 0.026) respectively], but nighttime HR was not significantly influenced by RDN (WMD = −2.08, 95% CI: −4.57 to 0.42, p = 0.103). We found that the reduction of HR was highly related to the decrease of SBP (r = 0.658, p < 0.05).Conclusion:Renal denervation could reduce office, 24-h, and daytime HR, but does not affect nighttime HR. And the effect is highly associated with blood pressure (BP) control.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021283065.

How Efficient are the Romanian Sports Federations? A Theoretical and Experimental Approach

Examining the links between performance and financial issues has been, and still is, subject of a great number of researches both in the business and in the non-profit environment. In this respect, the world of sports has not been bypassed either, using concepts and / or instruments from accounting, economics or statistic areas in order to analyse a firm or an NGO in the sport industry and his success. The present study represents one of the first attempt to value the Romanian sports federations’ activity which is not based solely on the scores attained following places and medals won by athletes participating in the national and international competition system. And it is intended to identify an appropriate methodology to highlight how efficient the sports federations have been in 2019 year, reporting the results obtained to the resources used, from a domestic perspective (meaning the participation in national sports events and the scores obtained). This paper addresses 12 Romanian sports federations (out of 75 federations on sport branches) and their efficiency, through the lens of several input, output and outcome indicators, using public data gathered from various sources - the Romanian Ministry of Finance, the National Institute of Statistics, the Romanian Ministry of Youth and Sports. Using statistical tools, such as Spearman rank correlation, as well as statistical methods, such as standardization, we developed an efficiency calculation methodology, which could be used to support managerial team to improve and / or reshape federations' activities, if necessary.

Reducing infantile anemia: insight on patterns of process and outcome indicators by ethnicity and socioeconomic class during a 10-year intervention program and 5 years after

Background In 2005, Clalit Health Services (CHS), the largest health maintenance organization in Israel, initiated an intervention program aimed at reducing the prevalence rate of infantile anemia (IA). This study evaluated the progress made during the intervention (2005–2014) and its yield 5 years after it ended (2019). Methods The CHS database was retrospectively reviewed twice yearly from 2005 to 2014 for repetitive samples of children aged 9 to 18 months regarding the previous half-year interval, and a single sample in 2019. Data were collected on gender, ethnicity (Jewish/non-Jewish), socioeconomic class (SEC; low/intermediate/high), hemoglobin testing (yes/no), and hemoglobin level (if tested). Excluded were infants with documented or suspected hemoglobinopathy. Results At study initiation, the rate of performance of hemoglobin testing was 54.7%, and the IA prevalence rate was 7.8%. The performance rate was lower in the Jewish than the non-Jewish subpopulation. The low-SEC subpopulation had a similar hemoglobin testing rate to the high-SEC subpopulation but double the IA prevalence rate. Overall, by the end of the intervention (2014), the performance rate increased to 87.5%, and the AI prevalence rate decreased to 3.4%. In 2019, there was little change in the performance rate from the end of the intervention (88%) and the IA prevalence was further reduced to 2.7%. The non-Jewish and low-SEC subpopulations showed the most improvement which was maintained and even bettered 5 years after the intervention ended. Conclusions The 10-year IA intervention program introduced by CHS in 2005 led to a reduction in IA prevalence rate to about 3.5% in all sub-populations evaluated. By program end, the results in the weaker subpopulations, which had the highest prevalence of IA at baseline, were not inferior to those in the stronger subpopulations. We recommended to the Israel Ministry of Health to adopt the intervention countrywide, and we challenge other countries to consider similar interventions.

NILAI MANFAAT DAN TINGKAT PENERAPAN MATERI PELATIHAN LITERASI DAN EDUKASI KEUANGAN (PLEK)

The lack of awareness and ability in recording and managing the finances of farming and farmer households causes farmers can’t get a real of their welfare. Farmers are still oriented to production activities and have not led to a profitable business through professional financial management. Training is one of the activities carried out as an effort to provide financial literacy and education for farming and farmer households. This study aims to determine the value of benefits and the level of application of financial literacy and education training materials which consist of 2 core materials, namely farming finance management and household financial management. The research method uses purposive sampling with 29 respondents from the Tuban, Ngawi, Lamongan, Madiun and Jombang regencies of East Java Province as participants in financial literacy and education training in 2019 and 2020. The results showed that the two materials were considered useful about 4.35 and 4.27 and the level of application of the materials was still at 50% or about 3.23 and 3.07 from the specified learning outcome indicators. The value of benefits is positively correlated with the application of the two training materials.It is necessary to improve the training module to make it simpler, easier to understand and aplicable by participants as well as intensive assistance from local extention officer so the material can be applied more optimally in farmer daily activities. ABSTRAKRendahnya kesadaran dan kemampuan dalam pencatatan dan pengelolaan keuangan usahatani dan rumah tangga petani menyebabkan kesejahteraan kurang dirasakan oleh petani. Petani selama ini masih berorientasi pada kegiatan produksi dan belum mengarah pada bisnis yang menguntungkan melalui pengelolaan keuangan yang profesional. Pelatihan merupakan salah satu kegiatan yang dilakukan sebagai upaya untuk memberikan literasi dan edukasi keuangan baik usahatani maupun rumah tangga petani. Penelitian ini bertujuan untuk mengetahui nilai manfaat dan tingkat penerapan materi pelatihan literasi dan edukasi keuangan yang terdiri dari 2 materi inti yaitu pengelolaan keuangan usahatani dan pengelolaan keuangan rumah tangga. Metode penelitian menggunakan purposive sampling dengan responden alumni peserta pelatihan literasi dan edukasi keuangan tahun 2019 dan 2020 yang berasal dari Kabupaten Tuban, Ngawi, Lamongan, Madiun dan Jombang Provinsi Jawa Timur sebanyak 29 orang. Hasil penelitian menunjukkan bahwa kedua materi dinilai bermanfaat yaitu sebesar 4,35 dan 4,27 serta tingkat penerapan materi sebesar 3,23 dan 3,07 atau masih 50% dari indikator hasil pembelajaran yang ditetapkan. Nilai manfaat berkorelasi secara positif terhadap penerapan kedua materi pelatihan. Perlu perbaikan modul pelatihan agar lebih sederhana, mudah dipahami dan diterapkan oleh peserta serta pendampingan yang intensif dari penyuluh pertanian setempat agar penerapan materi lebih optimal dan bermanfaat dalam kegiatan sehari-hari.

Board level “Picture-Understanding-Action”: a new way of looking at quality

PurposeThe purpose of this study is to present a quality improvement approach titled “Picture-Understanding-Action” used in Ireland to enhance the role of healthcare boards in the oversight of healthcare quality and its improvement.Design/methodology/approachThe novel and practical “Picture-Understanding-Action” approach was implemented using the Model for Improvement to iteratively introduce changes across three quality improvement projects. This approach outlines the concepts and activities used at each step to support planning and implementation of processes that allow a board to effectively achieve its role in overseeing and improving quality. This approach matured over three quality improvement projects.FindingsThe “Picture” included quantitative and qualitative aspects. The quantitative “Picture” consisted of a quality dashboard/profile of board selected outcome indicators representative of the health system using statistical process control (SPC) charts to focus discussion on real signals of change. The qualitative picture was based on the experience of people who use and work in health services which “people-ised” the numbers. Probing this “Picture” with collective grounding, curiosity and expert training/facilitation developed a shared “Understanding”. This led to “Action(s)” from board members to improve the “Picture” and “Understanding” (feedback action), to ask better questions and make better decisions and recommendations to the executive (feed-forward action). The Model for Improvement, Plan-Do-Study-Act cycles and a co-design approach in design and implementation were key to success.Originality/valueTo the authors’ knowledge, this is the first time a board has undertaken a quality improvement (QI) project to enhance its own processes. It addresses a gap in research by outlining actions that boards can take to improve their oversight of quality of care.

Effect of Pericytes on Cerebral Microvasculature at Different Time Points of Stroke

Pericyte, as an important component of the blood-brain barrier, has received increasing attention in the study of cerebrovascular diseases. However, the mechanism of pericytes after the occurrence of cerebral ischemia is controversial. On the one hand, the expression of pericytes increases after cerebral ischemia, constricting the blood vessels to restrict blood supply and aggravating the damage caused by ischemia; on the other hand, pericytes participate in capillary angiogenesis in the ischemic area, which facilitates the repair of the ischemic injury area. The multifunctionality of pericytes is an important reason for this phenomenon, but the different time points of observation for the outcome indicators in each study are also an important factor that leads to the controversy of pericytes. Based on the review of a large database of original studies, the authors’ team summarized the effects of pericytes on cerebral microvasculature at different time points after stroke, searched the possible markers, and explored possible therapeutic.

The Manchester Framework For The Evaluation of Emergency Department Pharmacy Services

Background: Many countries, including the United Kingdom, have established Emergency Department (ED) pharmacy services where some ED pharmacists now work as practitioners. They provide both traditional pharmaceutical care and novel practitioner care i.e. clinical examination, yet their impact on quality of care is unknown.Aim: To develop a framework of structures, processes and potential outcome indicators to support evaluation of the quality of ED pharmacy services in future studies.Method: Framework components (structures, processes and potential outcome indicators) were identified in three ways, from a narrative review of relevant international literature identified through systematic searches; a panel meeting with ED pharmacists; and a panel meeting with other ED healthcare professionals. Structures and processes were collated into categories developed iteratively throughout data collection, with outcome indicators collated into six domains of quality as proposed by the Institute of Medicine. These raw data were then processed e.g. outcome indicators screened for clarity i.e. those which explicitly stated what would be measured were included in the framework.Results: A total of 190 structures, 533 processes, and 503 outcome indicators were identified. Through data processing a total of 153 outcome indicators were included in the final framework divided into the domains safe (32 outcome indicators), effective (50), patient centred (18), timely (24), efficient (20) and equitable (9). Fewer potential outcome indicators were identified for the patient centred, efficient and equitable domains than others. Conclusion: Whilst frameworks to support evaluation of general ED care exist, this is the first framework specific to ED pharmacy services. Although included in the framework, potential outcome indicators require further development prior to their use in evaluation studies. To that end, evaluation teams should be multidisciplinary and ideally involve researchers with expertise in outcome measurement. Finally, evaluation should not neglect some domains of quality at the expense of others, as previously found by the Institute of Medicine. High quality health services are not only safe, effective and timely, but also patient centred, efficient and equitable.

Meta-analysis for the Relationship Between Hyperuricemia and CVD Incidence

BACKGROUND: Uric acid was once considered an effective endogenous antioxidant, but now more and more evidence shows that it may play a significant role in the pathophysiology of cardiovascular diseases.OBJECTIVES: It has not been clear that UA is a sign of poor prognosis or a risk factor for CVD. Our aim is to figure out the exact relationship between CVD and uric acid. METHODS: We studied 3356 publications in the past 44 years through MEDLINE, EMBASE, and Cochrane library searches, and selected 22 studies that met our inclusion criteria. RESULTS: The meta-analysis showed that hyperuricemia was associated with an increased risk of death from CVD (RR=1.37; 95% CI:1.29-1.45; I2=31.4%, P=0.157). Sensitivity analysis reviewed several potential sources of heterogeneity between studies, such as average SUA level, study location, and outcome indicators.

But How Will We Measure It? Co-Creating Assessments of Outcomes in Age-Friendly Care, PA

Moving from concept to quantitative measurement can be complex. There were several challenges in co-designing measures to assess the impact of Age-Friendly Care, PA, a geriatric workforce enhancement program. First as a FQHC, our clinical partner had not captured the metrics of interest. Second, the co-developed operational definitions for our metrics should be feasible, relevant, and useful for all project members. Third, funder reporting requirements must also be addressed. Working within this context, we co-created 11 outcome indicators structured around the 4Ms (IHI) now with 9 months of data. EMR changes to make data reportable included measuring opioid misuse mitigation, high-risk medication elimination, cognitive assessment and dementia care management, advanced care planning, care partner presence, annual wellness visit completion, pneumonia vaccination rates, colorectal screening rates, mobility goal tracking, and presence of a caregiver. Work continues around formulating themes to create a reportable mechanism for assessing What Matters.

Skin‐patch Of Ding Zi Gao on Relieving Local and Systemic Symptoms in Patients with Moderate to Severe Periodic Mastalgia: A Randomized, Double‐Blind Trial

Background and purpose: The use of hormone receptor agent drugs such as androgens (tamoxifen) for the treatment of moderate and severe breast pain has limitations such as cardiac, hepatic, and nephrotoxicity and gastrointestinal side effects. Therefore, there is a need to prescribe a new safe and effective topical treatment method to reduce the use of anti-inflammatory and hormonal agent drugs, the incidence of adverse effects and the financial burden on patients. This randomized controlled clinical trial investigates the clinical efficiency and safety of Skin‐patch of Ding Zi Gao (DZG) acupoint-application therapy for the treatment of moderate to severe Periodic mastalgia (MSPM), and provides a basis for the design of an optimized, safe and effective comprehensive treatment plan for MSPM.Methods: Sixty patients with moderate to severe Periodic mastalgia (MSPM) who met the inclusion criteria were selected from the breast clinic of Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University and randomly divided into 30 cases in the treatment group and 30 cases in the control group. The treatment group was treated by Skin‐patch of Ding Zi Gao (DZG) acupoint-application therapy, which was applied from the 3rd day after the end of menstruation, once a day, for 6-8 h each time, 14 times as a course of treatment, and the treatment was completed within 1 month, and the application was stopped during menstruation. The control group was treated with skin patches of placebo acupoint application, and the duration and course of treatment were the same as that of the treatment group. During the 14 day course of treatment and 2-month follow-up after the experiment, the main outcome indicators (including Breast pain improvement onset time, change in breast pain VAS score, change in patient's mood, sleep, Fullness in both flank, (McGill Pain Questionnaire) MPQ and secondary outcome indicators ( Including changes in breast nodule size and gland thickness guided by breast ultrasound, VAS pain score in the 2-month follow-up at the end of treatment, and adverse reactions), At the same time, the safety of the scheme was evaluated.RESULTS: There were no differences between the two groups in terms of age, body mass index, history of breastfeeding, family history of breast disease, history of allergies, history of breast surgery, or duration of breast pain (months) before recruitment. The comparison between pre-treatment and post-treatment showed that the time to onset of breast pain improvement, visual analogue score (VAS) of breast pain, improvement in mood, sleep, fullness in both flank and the MPQ were significantly lower in both groups after treatment, and the improvement was more significant in the treatment group than in the placebo control group (P < 0.05). Both groups showed significant reductions in improving patient mammography outcomes and VAS pain scores at two months of follow-up, but there were no significant differences between the groups. In terms of safety evaluation, no significant differences in the incidence of adverse events were found.CONCLUSION: point-application treatment with skin patches of Ding Zi Gao (DZG) therapy in patients with MSPM improved breast pain and swelling, reduced breast gland thickness, and decreased breast visual analogue pain score (VAS) and MPQ score. Its efficacy was significantly better than skin patches of placebo acupoint application therapy alone. This study provides a basis for the clinical application of DZG for MSPM.