Comparison of the effectiveness of radial extracorporeal shock wave therapy and supervised exercises with neuromuscular inhibition technique in lateral epicondylitis: A randomized-controlled t

Objectives: The aim of this study was to evaluate and compare the effects of radial extracorporeal shock wave therapy (rESWT) and supervised exercises with neuromuscular inhibition (NMI) technique in improving pain, function, and grip strength in the treatment of patients with lateral epicondylitis (LE). Patients and methods: A total of 50 patients with LE (11 males, 30 females; median age: 46 years; range, 23 to 57 years) whose symptoms persisted for at least three months between February 2015 and August 2015 were included in the prospective, randomized-controlled, clinical study. The patients were divided into two groups as the rESWT group (n=25) receiving a total of three rESWT sessions (once per week with 1.8 bar pneumatic pressure, 10 Hz frequency, and with 2,000 pulses) and the exercise group (n=25) receiving supervised exercises with NMI (three times per week for three weeks). Pain and function were evaluated using Visual Analog Scale, the total Patient-Rated Tennis Elbow Evaluation, the Roles and Maudsley score, while the grip strength was evaluated using a hand dynamometer at one and three months after treatment compared to baseline. Results: A significant improvement was observed in all outcome criteria at one and three months after treatment, compared to baseline, in both the rESWT and exercise groups (p<0.05). There was no significant difference in terms of the changes in the outcome criteria between the groups (p>0.05). Conclusion: The rESWT seems to provide no significantly superior benefit than supervised exercises with NMI at least until the three months in the treatment of LE.

Developing a new national MDMA policy: Results of a multi-decision multi-criterion decision analysis

Background: Ecstasy (3,4-methylenedioxymethamphetamine (MDMA)) has a relatively low harm and low dependence liability but is scheduled on List I of the Dutch Opium Act (‘hard drugs’). Concerns surrounding increasing MDMA-related criminality coupled with the possibly inappropriate scheduling of MDMA initiated a debate to revise the current Dutch ecstasy policy. Methods: An interdisciplinary group of 18 experts on health, social harms and drug criminality and law enforcement reformulated the science-based Dutch MDMA policy using multi-decision multi-criterion decision analysis (MD-MCDA). The experts collectively formulated policy instruments and rated their effects on 25 outcome criteria, including health, criminality, law enforcement and financial issues, thematically grouped in six clusters. Results: The experts scored the effect of 22 policy instruments, each with between two and seven different mutually exclusive options, on 25 outcome criteria. The optimal policy model was defined by the set of 22 policy instrument options which gave the highest overall score on the 25 outcome criteria. Implementation of the optimal policy model, including regulated MDMA sales, decreases health harms, MDMA-related organised crime and environmental damage, as well as increases state revenues and quality of MDMA products and user information. This model was slightly modified to increase its political feasibility. Sensitivity analyses showed that the outcomes of the current MD-MCDA are robust and independent of variability in weight values. Conclusion: The present results provide a feasible and realistic set of policy instrument options to revise the legislation towards a rational MDMA policy that is likely to reduce both adverse (public) health risks and MDMA-related criminal burden.

Developing a new national MDMA policy: Results of a multi-decision multi-criterion decision analysis (MD-MCDA)

Background: MDMA (ecstasy, 3,4-methylenedioxymethamphetamine) has a relatively low harm and low dependence liability but is scheduled on List I of the Dutch Opium Act together (“hard drugs”). Concerns surrounding increasing MDMA-related criminality coupled with the possibly inappropriate scheduling of MDMA initiated a debate to revise the current Dutch ecstasy policy.Methods: An interdisciplinary group of eighteen experts on health, social harms, and drug criminality and law enforcement reformulated science-based the Dutch MDMA policy using multi-decision multi-criterion decision analysis (MD-MCDA). The experts collectively formulated policy instruments and rated their effects on 25 outcome criteria, including health, criminality, law enforcement and financial issues, thematically grouped in six clusters.Results: [WILL BE ADDED ON 2020-11-13]Conclusion: [WILL BE ADDED ON 2020-11-13]

The Modified Arch Landing Areas Nomenclature predicts proximal endograft failure after thoracic endovascular aortic repair

OBJECTIVES Our goal was to assess the value of the Modified Arch Landing Areas Nomenclature (MALAN) for thoracic endovascular aortic repair (TEVAR), in which each landing area (LA) is identified by a proximal landing zone and the type of arch (e.g. 0/I), as predictors of postoperative proximal endograft performance. METHODS A multicentre retrospective analysis was performed of patients treated with arch TEVAR (i.e. proximal landing zone 0–3) for various indications between 2007 and 2017. Patients were stratified by the MALAN classification into hostile LAs (i.e. 2/III and 3/III) and favourable LAs (i.e. 0/I–III, 1/I–III, 2/I–II and 3/I–II). Outcome criteria included composite proximal endograft failure (including type Ia endoleak, persistent false lumen perfusion at the level of the most proximal communication between the lumina in aortic dissections, endograft migration and retrograde dissection) and deaths from all causes. Competing risk analyses were performed. RESULTS A total of 359 patients (hostile LAs 133; favourable LAs 226) were identified. The median age was 71.0 (62.0–77.0); 78.3% were men. Proximal endograft failure occurred in 28/133 patients (21.1%) in the hostile LA group and in 12/226 (5.3%) in the favourable LA group. On multivariate analysis, hostile LAs were independently associated with proximal endograft failure (P &lt; 0.0001). There was no other independent risk factor. Favourable LAs were associated with an increased mortality rate (P = 0.006), which could be attributed to the proximal LA subgroup (i.e. 0/I–III and 1/I–III) (P &lt; 0.0001), in addition to age (P &lt; 0.0001). CONCLUSIONS The MALAN classification identifies hostile proximal landing zones for TEVAR, namely 2/III and 3/III LAs, which are associated with dismal proximal endograft performance. The MALAN appears to be an intuitive and valuable tool to improve the preoperative decision-making process.

Large volume infusions of hydroxyethyl starch during cardiothoracic surgery may be associated with postoperative kidney injury: propensity-matched analysis

Background The safety of intraoperative administration of hydroxyethyl starch (HES) has been debated. We hypothesized that intraoperative use of HES is associated with postoperative acute kidney injury (AKI) following cardiopulmonary bypass (CPB). Materials and methods Patients who underwent cardiothoracic surgery using CPB between 2007 and 2014 were retrospectively reviewed. The incidence of AKI within 7 days after surgery, defined by the Kidney Disease Improving Global Outcome criteria, was compared for patients who did or did not receive 6% (70/0.5) or 6% (130/0.4) HES for anesthesia management before or after CPB. Multivariable logistic regression and propensity matching analysis were performed to examine whether use of HES is associated with postoperative AKI. Outcomes comparing patients receiving HES ≥ 1000 mL and < 1000 mL were also compared. Results Data from 1976 patients were reviewed. All patients received 70/0.5 HES as a part of the priming solution for CPB. The incidence of postoperative AKI was 28.2% in patients who received HES and 26.0% in patients who did not (p = 0.33). In multivariable analysis, there was no correlation between the use of HES and the incidence of AKI (odds ratio 0.87, 95% CI 0.30–2.58, p = 0.81). Propensity matching showed that the incidence of AKI was not significantly different between 481 patients administered with HES and 962 patients (26.6% vs. 26.9%, p = 0.95) who did not receive HES for anesthesia management. However, peak creatinine levels, needed for renal replacement therapy, and in-hospital mortality were higher, and 28-day hospital-free days were lower in patients receiving HES ≥ 1000 mL than those receiving HES < 1000 mL (p < 0.05). Conclusions Intraoperative use of HES was not associated with postoperative AKI following CPB. However, administration of large volumes of HES may be associated with kidney-related adverse clinical outcomes.

Transformational Leadership, Task-Involving Climate, and Their Implications in Male Junior Soccer Players: A Multilevel Approach

Despite the well-known positive consequences of transformational coaches in sport, there is still little research exploring the mechanisms through which coaches’ transformational leadership exerts its impact on athletes. Multilevel SEM was used to examine the relationship between coaches’ transformational leadership style, a task-involving climate, and leadership effectiveness outcome criteria (i.e., players’ extra effort, coach effectiveness, and satisfaction with their coach), separately estimating between and within effects. A representative sample of 625 Spanish male soccer players ranging from 16 to 18 years old and nested in 50 teams completed a questionnaire package tapping the variables of interest. Results confirmed that at the team level, team perceptions of transformational leadership positively predicted teams’ perceptions of task climate, which in turn positively predicted the three outcome criteria. At the individual level, players’ perceptions of transformational leadership positively predicted teams’ perceptions of task climate, which in turn positively predicted teams’ extra effort and coach effectiveness. Mediation effects appeared at the team level for all the outcome criteria, and at the individual only for extra effort. Transformational leadership is recommended to enhance task climate, in order to increase players’ extra effort, their perceptions of the effectiveness of their coach, and their satisfaction with his/her leadership style.

Nurse Trend in Writing Objectives and Outcome Criteria of Nursing Diagnosis in Patients With Pulmonary Tuberculosis at The Government Hospital in Salatiga Indonesia

Background. Writing nursing goals and outcome criteria found in nursing care documentation was very varied and not appropriately, it needs to be explored more deeply about the phenomenon. The Study objective was to determine the writing of nursing goals and the outcome criteria for nursing diagnoses. Methods. Research design was qualitative research with a direct observation approach. Data was taken in the MDR TB ward, samples were 100 documentation of pulmonary TB patients. Sampling technique was nonprobability sampling. Result. The goal of nursing diagnosis of ineffective airway clearance was airway clearance effectively again, the problem was resolved, the patient's airway returned to normal and coughing the patient returns to normal, etc. The goal of nursing diagnosis of ineffective breathing patterns was effective breathing patterns, ineffective breathing patterns resolved, etc. The outcome criteria of nursing diagnosis ineffective airway clearence was negative cough, normal respiratory rate, normal vital signs, negative sputum, shortness of breath, coughing resolved, comfortable patients, patients can demonstrate coughing effectively, sputum can come out, breath was relieved, sputum can come out, etc. The outcome criteria for nursing diagnosis ineffective breathing patterns are normal respiratory rate, normal vital signs, respiratory rate was 20 x/minute, it was not weakness, It was not nausea, etc. Recomendation. Nurses are advised to be given trainings, sosialisation, or workshops related to the goals and outcome criteria of nursing diagnoses, and are expected to use NANDA and NIC-NOC references.

Progesterone – Effective for Tocolysis and Maintenance Treatment After Arrested Preterm Labour?

Numerous experimental studies indicate that natural progesterone, through various mechanisms, exerts an inhibitory effect on uterine contractility and sensitises the myometrium for tocolytics. It was therefore appropriate to investigate the possible benefits of oral/vaginal progesterone and the synthetic progesterone derivative 17-α-hydroxyprogesterone caproate, applied intramuscularly, in clinical studies on primary tocolysis, additively to established tocolytics (“adjunctive tocolysis”) and as maintenance treatment after successful tocolysis in cases of threatened preterm birth. Three studies with a small number of cases do not yield any sufficient evidence for recommending progesterone/17-α-hydroxyprogesterone caproate as primary tocolysis in women with preterm labour. There is also no evidence that progesterone or 17-α-hydroxyprogesterone caproate combined with commonly used tocolytics leads to a prolongation of pregnancy and a significant decrease in the rate of preterm birth. The data on the use of progesterone as maintenance treatment is controversial. While randomised, controlled studies with low quality showed promising results, studies with high quality did not reveal any significant differences with regard to the rate of preterm birth < 37 weeks of gestation, the latency period until delivery and in the neonatal outcome between progesterone/17-α-hydroxyprogesterone caproate and placebo or no treatment. Significant differences in the methodology, the inclusion and outcome criteria, the mode of application and the dosages of the substances as well as the inadequate statistical power as a result of low numbers of cases make interpretation and comparability of the studies difficult. Therefore, well-designed randomised, placebo-controlled, double-blind studies with uniform primary outcome criteria are needed in order to clarify whether progesterone and via which route of administration and at which dosage is of clinical benefit for patients with manifest preterm contractions and as maintenance treatment after arrested preterm labour.