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Aim: Although referral to phase 2 cardiac rehabilitation (CR) following open-heart surgery is recommended in professional guidelines, according to the literature, participation rates are suboptimal. This study investigates the referral and enrolment rates, as well as determinants for these rates, for phase 2 CR following open-heart surgery via sternotomy. Methods: A cross-sectional survey study was conducted among patients who underwent open-heart surgery via sternotomy in a university hospital. Data on referral and enrolment rates and possible factors associated with these rates (age, sex, type of surgery, educational level, living status, employment, income, ethnicity) were collected by a questionnaire or from the patient's medical file. Univariate logistic regression analysis (odds ratio) was used to study associations of patient characteristics with referral and enrolment rates. Results: Of the 717 eligible patients, 364 (51%) completed the questionnaire. Their median age was 68 years (interquartile range 61–74) and 82 (23%) were female. Rates for referral to and enrolment in phase 2 CR were 307 (84%) and 315 (87%), respectively. Female sex and older age were independently associated with both non-referral and non-enrolment. Additional factors for non-enrolment were surgery type (coronary artery bypass grafting with valve surgery and miscellaneous types of relatively rare surgery), living alone and below-average income. Conclusion: Phase 2 CR referral and enrolment rates for patients following open-heart surgery were well over 80%, suggesting adequate adherence to professional guidelines. During consultation, physicians and specialised nurses should pay more attention to certain patient groups (at risk of non-enrolment females and elderly). In addition, in-depth qualitative research to identify reasons for non-referral and/or non-enrolment is needed. [ABSTRACT FROM AUTHOR]

Background: The global utilization of the physician assistant/associate (PA) is growing. Their increasing presence is in response to the rising demands of demographic changes, new developments in healthcare, and physician shortages. While PAs are present on four continents, the evidence of whether their employment contributes to more efficient healthcare has not been assessed in the aggregate. We undertook a systematic review of the literature on PA cost-effectiveness as compared to physicians. Cost-effectiveness was operationalized as quality, accessibility, and the cost of care. Methods and findings: Literature to June 2021 was searched across five biomedical databases and filtered for eligibility. Publications that met the inclusion criteria were categorized by date, country, design, and results by three researchers independently. All studies were screened with the Risk of Bias in Non-randomised Studies—of Interventions (ROBIN-I) tool. The literature search produced 4,855 titles, and after applying criteria, 39 studies met inclusion (34 North America, 4 Europe, 1 Africa). Ten studies had a prospective design, and 29 were retrospective. Four studies were assessed as biased in results reporting. While most studies included a small number of PAs, five studies were national in origin and assessed the employment of a few hundred PAs and their care of thousands of patients. In 34 studies, the PA was employed as a substitute for traditional physician services, and in five studies, the PA was employed in a complementary role. The quality of care delivered by a PA was comparable to a physician's care in 15 studies, and in 18 studies, the quality of care exceeded that of a physician. In total, 29 studies showed that both labor and resource costs were lower when the PA delivered the care than when the physician delivered the care. Conclusions: Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care. Sometimes this efficiency was due to their reduced labor cost and sometimes because they were more effective as producers of care and activity. [ABSTRACT FROM AUTHOR]

Freestanding silicon nitride membranes with thicknesses down to a few tens of nanometers find use as TEM windows or soft X-ray spectral purity filters. As the thickness of a membrane decreases, emissivity vanishes, which limits radiative heat emission and resistance to heat loads. We show that thin metal layers with thicknesses in the order of 1 nm enhance the emissivity of thin membranes by two to three orders of magnitude close to the theoretical limit of 0.5. This considerably increases thermal load capacity of membranes in vacuum environments. Our experimental results are in line with classical theory in which we adapt thickness dependent scattering terms in the Drude and Lorentz oscillators. [ABSTRACT FROM AUTHOR]

In this paper, we study the evolution of phase-separating binary mixtures which are subjected to alternate cooling and heating cycles. An initially homogeneous mixture is rapidly quenched to a temperature T1c, where Tc is the critical temperature. The mixture undergoes phase separation for a while and is then suddenly heated to a temperature T2>Tc. These cycles are repeated to create a domain morphology with multiple length scales, i.e., the structure factor is characterized by multiple peaks. For phase separation in d = 2 systems, we present numerical and analytical results for the emergence and growth of this multiple-scale morphology. [ABSTRACT FROM AUTHOR]

Objective: Inactivity during hospitalization leads to a functional decline and an increased risk of complications. To date, studies focused on older adults. This study aims to compare the physical activities performed by older adult and adult hospitalized patients. Methods: Patients hospitalized for >3 days at a university hospital completed a questionnaire regarding their physical activities (% of days on which an activity was performed divided by the length of stay) and physical activity needs during hospitalization. Crude and adjusted comparisons of older adult (>60 years) and adult (=60 years) patients were performed using parametric testing and regression analyses. Results: Of 524 patients, 336 (64%) completed the questionnaire, including 166 (49%) older adult patients. On average, the patients were physically active on 35% or less of the days during their hospitalization. Linear regression analysis showed no significant associations between being an older adult and performing physical activities after adjusting for gender, length of stay, surgical intervention, and meeting physical activity recommendations prior to hospitalization. Most patients were well informed regarding physical activity during hospitalization; however, the older adult patients reported a need for information regarding physical activities after hospitalization more frequently (odds ratios, 2.47) after adjusting for educational level, gender, and physical therapy during hospitalization. Conclusions: Both older adult and adult patients are physically inactive during hospitalization, and older adult patients express a greater need for additional information regarding physical activity after hospitalization than adult patients. Therefore, personalized strategies that inform and motivate patients to resume physical activities during hospitalization are needed regardless of age. [ABSTRACT FROM AUTHOR]

The Nociception Coma Scale is a nociception behaviour observation tool, developed specifically for patients with disorders of consciousness (DOC) due to (acquired) brain injury. Over the years, the clinimetric properties of the NCS and its revised version (NCS-R) have been assessed, but no formal summary of these properties has been made. Therefore, we performed a systematic review on the clinimetric properties (i.e. reliability, validity, responsiveness and interpretability) of the NCS(-R). We systematically searched CENTRAL, CINAHL, Embase, PsycInfo and Web of Science until August 2015. Two reviewers independently selected the clinimetric studies and extracted data with a structured form. Included studies were appraised on quality with the COSMIN checklist. Eight studies were found eligible and were appraised with the COSMIN checklist. Although nearly all studies lacked sample size calculation, and were executed by the same group of authors, the methodological quality ranged from fair to excellent. Important aspects of reliability, construct validity and responsiveness have been studied in depth and with sufficient methodological quality. The overview of clinimetric properties in this study shows that the NCS and NCS-R are both valid and useful instruments to assess nociceptive behaviour in DOC patients. The studies provide guidance for the choice in NCS-R cut-off value for possible pain treatment and cautions awareness of interprofessional differences in NCS-R measurements.Significance: This systematic review provides a structured overview of the clinimetric properties of the Nociception Coma Scale (-Revised) and provides insights for a solid evidence-based nociception behaviour assessment and treatment plan. [ABSTRACT FROM AUTHOR]

The article focuses on a pilot randomized clinical trial. on probiotics-impregnated bedding covers for house dust mite allergic rhinitis (AR). AR affects up to one-third of the adult population and causes illness and disability world-wide. Main symptoms include sneezing, rhinorrhea and nasal obstruction.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) bring relief of pain and functional disability to patients with end-stage osteoarthritis, and however, the literature on their impact on patients' level of physical activity (PA) is scarce. Cross-sectional study in patients who underwent THA/TKA surgery in the preceding 6-22 months and a random sample of persons aged >40 years from the Dutch general population, participating in a national survey. PA in minutes per week (min/week) and adherence to the Dutch recommendation for PA (NNGB yes/no) were measured by the short questionnaire to assess health-enhancing PA. Multivariable linear (total min/week) and logistic regression analyses (meeting recommendations PA), adjusting for confounders, were performed for THA and TKA separately. In total, 258 THA [62.3% female, aged 69.4 (9.1)] and 221 TKA [65.7% female, aged 69.5 (8.9)] patients and 4373 persons from the Dutch general population [51.4% female, aged 58.9 (11.6)] were included. The presence of THA was associated after adjusting for age, sex, BMI education and musculoskeletal comorbidities, with more total min/week spent on PA (THA 13.8% increase, 95% CI 1.6-27.6%), whilst both TJA groups were associated with adhering to NNGB (THA: OR 1.79, 95% CI 1.26-2.56; TKA: OR 1.73, 95% CI 1.20-2.51). As this study used questionnaires to compare the PA of THA/TKA patients to the general population, some recall and selection bias might have been induced. After surgery, overall, TJA patients are more likely to adhere NNGB than a representative sample of persons >40 years from the Dutch general population. [ABSTRACT FROM AUTHOR]

The COMFORT scale is a measurement tool to assess distress, sedation and pain in nonverbal paediatric patients. Several studies have described the COMFORT scale, but no formal assessment of the methodological quality has been undertaken. Therefore, we performed a systematic review to study the clinimetric properties of the (modified) COMFORT scale in children up to 18 years. We searched Central, CINAHL, Embase, Medline, PsycInfo and Web of Science until December 2014. The selection, data extraction and quality assessment were performed independently by two reviewers. Quality of the included studies was appraised using the COSMIN checklist. We found 30 studies that met the inclusion criteria. Most participants were ventilated children up to 4 years without neurological disorders. The results on internal consistency and interrater reliability showed values of >0.70 in most studies, indicating an adequate reliability. Construct validity resulted in correlations between 0.68 and 0.84 for distress, between 0.42 and 0.94 for sedation and between 0.31 and 0.96 for pain. The responsiveness of the (modified) COMFORT scale seems to be adequate. The quality of the included studies ranged from poor to excellent. The COMFORT scale shows overall an adequate reliability in providing information on distress, sedation and pain. Construct validity varies from good to excellent for distress, from moderate to excellent for sedation, and from poor to excellent for pain. The included studies were clinically and methodologically heterogeneous, hampering firm conclusions. WHAT DOES THIS REVIEW ADD?: An in-depth assessment of the clinimetric properties of the COMFORT scale. The COMFORT scale shows overall an adequate reliability in providing information on distress, sedation and pain. Construct validity varies from good to excellent for distress, from moderate to excellent for sedation, and from poor to excellent for pain. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine the relationship between comorbidities and pain, physical function and health-related quality of life (HRQoL) after total hip arthroplasty (THA) and total knee arthroplasty (TKA). A cross-sectional retrospective survey was conducted including 19 specific comorbidities, administered in patients who underwent THA or TKA in the previous 7-22 months in one of 4 hospitals. Outcome measures included pain, physical functioning, and HRQoL. Of the 521 patients (281 THA and 240 TKA) included, 449 (86 %) had ≥1 comorbidities. The most frequently reported comorbidities (>15 %) were severe back pain; neck/shoulder pain; elbow, wrist or hand pain; hypertension; incontinence of urine; hearing impairment; vision impairment; and cancer. Only the prevalence of cancer was significantly different between THA ( n = 38; 14 %) and TKA ( n = 52; 22 %) ( p = 0.01). The associations between a higher number of comorbidities and worse outcomes were stronger in THA than in TKA. In multivariate analyses including all comorbidities with a prevalence of >5 %, in THA dizziness in combination with falling and severe back pain, and in TKA dizziness in combination with falling, vision impairments, and elbow, wrist or hand pain was associated with worse outcomes in most of the analyses. A broad range of specific comorbidities needs to be taken into account with the interpretation of patients' health status after THA and TKA. More research including the ascertainment of comorbidities preoperatively is needed, but it is conceivable that in particular, the presence of dizziness with falling, pain in other joints, and vision impairments should be assessed and treated in order to decrease the chance of an unfavorable outcome. [ABSTRACT FROM AUTHOR]

Background The aim of the study was to assess the impact of an acute surgical admission ward on admission and discharge processes. Methods This prospective cohort study was conducted in a university tertiary referral centre. All acute surgical patients were clustered in the acute surgical unit ( ASU) in February and March 2012, and discharged or transferred to specialized departments within 48 h. The primary outcome was length of hospital stay ( LOS). Secondary outcomes were impact on emergency department waiting times, discharge home within 48 h, incorrect ward admissions, readmissions and mortality. Outcomes of the study group were compared with those of a historical reference group admitted during the same interval the year before. Results Some 249 patients were admitted to the ASU during the study interval. The reference group consisted of 211 patients. The total LOS decreased significantly from a median of 4·0 to 2·0 days ( P = 0·004). The percentage of patients who were discharged within 48 h increased from 30·3 to 43·4 per cent ( P = 0·004). The rate of incorrect ward admission decreased from 9·5 to 0 per cent. Emergency department waiting time, readmission rate and 30-day mortality did not change. Conclusion Introduction of an acute surgical unit-shortened length of hospital stay without comprising readmission and mortality rates. [ABSTRACT FROM AUTHOR]

Changes in the features of food demand and consumption have moved from the mass consumption model towards an increasing qualitative differentiation of products and demand. This movement towards addressing consumers’ demand for food products with more advanced quality attributes has led to increasingly complex food qualification processes and a proliferation of standards. Accompanying these changes in the agro-food system is a growing consumer concern for food safety and quality. One important attribute of “quality” is the origin of a food product. This paper focuses on lamb originating from the Karoo region of South Africa and tests consumers’ willingness to pay a premium for this specific origin attribute of the product. A randomnth price auction was conducted to obtain willingness to pay estimates for a premium on a 500g packet of certified Karoo lamb loin chops. Various demographic and behavioural variables were linked to participants’ individual bids in order to determine the possible influence of these variables on participants’ bidding behaviour. A general positive willingness to pay for certified Karoo lamb was observed, with an average premium of R21.80/ kg recorded for loin chops. The impact of additional information was clearly visible as bids increased substantially after additional information regarding the product was introduced. [ABSTRACT FROM PUBLISHER]

Background The aim was to study which dressing material was best for healing donor-site wounds (DSWs) after split-skin grafting as there is wide variation in existing methods, ranging from classical gauze dressings to modern silicone dressings. Methods This 14-centre, six-armed randomized clinical trial (stratified by centre) compared six wound dressing materials in adult patients with DSWs larger than 10 cm2. Primary outcomes were time to complete re-epithelialization and pain scores measured on a visual analogue scale (VAS) over 4 weeks. Secondary outcomes included itching (VAS, over 4 weeks), adverse events and scarring after 12 weeks rated using the Patient and Observer Scar Assessment Scale (POSAS). Results Between October 2009 and December 2011, 289 patients were randomized (of whom 288 were analysed) to either alginate (45), film (49), gauze (50), hydrocolloid (49), hydrofibre (47) or silicone (48) dressings. Time to complete re-epithelialization using hydrocolloid dressings was 7 days shorter than when any other dressing was used (median 16 versus 23 days; P < 0·001). Overall pain scores were low, and slightly lower with use of film dressings ( P = 0·038). The infection rate among patients treated with gauze was twice as high as in those who had other dressings (18 versus 7·6 per cent; relative risk 2·38, 95 per cent confidence interval 1·14 to 4·99). Patients who had a film dressing were least satisfied with overall scar quality. Conclusion This trial showed that use of hydrocolloid dressings led to the speediest healing of DSWs. Gauze dressing should be discontinued as they caused more infections. Registration number: NTR1849 (http://www.trialregister.nl). [ABSTRACT FROM AUTHOR]

This paper compares the performance of HTV (high temperature vulcanized) silicone rubber power line insulators under AC and both polarities DC when subjected to natural pollution. The investigation was conducted at Koeberg Pollution Test Station (KIPTS) which is situated near Cape Town and is known for its severe coastal pollution and high humidity during the night. High rainfall is experienced during winter. Five insulators of different creepage lengths and of the same manufacture were energized by each voltage type, while being exposed to the environment for 310 days. The leakage current data of all insulators were logged, together with the weather data. Pollution levels were measured on a regular basis, using the ESDD (equivalent salt deposit density) method and directional dust deposit gauges (DDDG). High leakage current levels were recorded in summer due to the high pollution levels and high humidity. During winter, in contrast, lower levels of leakage current were recorded, confirming the washing effect of the winter rain. The leakage current levels for the silicone rubber insulators were of a similar order of magnitude for AC and positive DC, but lower for negative DC. Electrical discharge activities on the insulators were recorded at night and surface erosion was monitored at set intervals. A polarity effect relating to pollution performance and aging was confirmed on DC energized insulators. [ABSTRACT FROM PUBLISHER]

Background: Evidence-based decision making has permeated the daily practice of healthcare professionals. However, in wound care this seems more difficult than in other medical areas, such as breast cancer, which has a similar incidence, variety of etiologies, financial burden, and diversity of treatment options. This incongruence could be due to a lack in quantity and quality of available evidence. We therefore compared worldwide publication trends to answer whether research in wound care lags behind that in breast cancer. Methods: In order to assess the trends in quantity and methodological quality of publications as to wound care and breast cancer treatments, we examined relevant publications over the last five decades. Publications in MEDLINE were classified into seven study design categories: (1) guidelines, (2) systematic reviews (SR), (3) randomized (RCT), and controlled clinical trials (CCT), (4) cohort studies, (5) case-control studies, (6) case series and case reports, and (7) other publications. Results: We found a 30-fold rise in publications on wound care, versus a 70-fold increase in those on breast cancer. High-quality study designs like SR, RCT, or CCT were less frequent in wound care (difference 1.9, 95 % CI 1.8-2.0 %) as were guidelines; 76 on wound care versus 231 for breast cancer. Conclusions: Publications on wound care fall behind in quantity and quality as compared to breast cancer. Nevertheless, SR, RCT, and CCT in wound care are becoming more numerous. These high-quality study designs could motivate clinicians to make evidence-based decisions and researchers to perform proper research in wound care. [ABSTRACT FROM AUTHOR]

Background: Decisions on local and systemic wound treatment vary among surgeons and are frequently based on expert opinion. The aim of this meta-review was to compile best available evidence from systematic reviews in order to formulate conclusions to support evidence-based decisions in clinical practice. Methods: All Cochrane systematic reviews (CSRs), published by the Cochrane Wounds and Peripheral Vascular Diseases Groups, and that investigated therapeutic and preventive interventions, were searched in the Cochrane Database up to June 2011. Two investigators independently categorized each intervention into five levels of evidence of effect, based on size and homogeneity, and the effect size of the outcomes. Results: After screening 149 CSRs, 44 relevant reviews were included. These contained 109 evidence-based conclusions: 30 on venous ulcers, 30 on acute wounds, 15 on pressure ulcers, 14 on diabetic ulcers, 12 on arterial ulcers and eight on miscellaneous chronic wounds. Strong conclusions could be drawn regarding the effectiveness of: therapeutic ultrasonography, mattresses, cleansing methods, closure of surgical wounds, honey, antibiotic prophylaxis, compression, lidocaine-prilocaine cream, skin grafting, antiseptics, pentoxifylline, debridement, hyperbaric oxygen therapy, granulocyte colony-stimulating factors, prostanoids and spinal cord stimulation. Conclusion: For some wound care interventions, robust evidence exists upon which clinical decisions should be based. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective and Setting: After successful implementation, adherence to hospital guidelines should be sustained. Long-term adherence to two hospital guidelines was audited. The overall aim was to explore factors accounting for their long-term adherence or non-adherence. [ABSTRACT FROM AUTHOR]

Food is a basic human physiological need that is important for survival, growth, health and general well-being. Without an adequate supply of food, a human being can neither grow or develop optimally, nor utilize energy for sustained livelihood, thereby implying food insecurity. South Africa (SA) is classified as a developing country, with developing countries representing a third of the world's population. Unfortunately, as is often the case in developing countries, limited up-to-date surveys and consumption data are available. In fact, SA has only ever had one National Food Consumption Survey (NFCS) in 1999, in preparation for the introduction of a food fortification programme. However, the available information still sketches the severity of the situation within emergent economies. It is recognised that modern rates of food inflation are a worldwide phenomenon and it is argued that SA as a case study presents a much wider insight than just an individual country. About 35% of the South African population is food insecure and categorized as being poor. With the current continual increase in food prices, especially staple food prices, most households need to employ food coping strategies to survive. Some of these strategies have a significant negative impact on their often already deprived nutritional status. The possible added impact of current inflation on the nutritional status of vulnerable South African households is discussed in this paper. A consequent potential reduction in portion sizes of staple foods consumed because of increased food prices, as well as a snapshot of the cost of a balanced varied diet compared with average household income, are presented in the context of SA's prevailing inadequate nutritional situation. [ABSTRACT FROM AUTHOR]

An experimental study was conducted, using the Inclined Plane Test method to determine the performance of typical power line insulator materials: RTV (Room Temperature Vulcanized) silicone rubber coated porcelain, HTV (High Temperature Vulcanized) silicone rubber and EPDM rubber. The constant voltage method was employed to evaluate the performance of the above samples when energized by ac and dc (both polarities) voltages. The relative performance of the different materials and the effect of the voltage types were investigated. The results show that the RTV silicone rubber coating exhibits the least erosion for ac voltage but shows extensive erosion in the case of negative dc voltage. The HTV silicone rubbers exhibit only minimal erosion when exposed to ac test voltage, but develop strong erosion under positive dc voltage, which can result in sample failure. EPDM experiences the least erosion for a negative dc voltage, but shows maximum erosion severity for ac voltage. [ABSTRACT FROM AUTHOR]

This paper presents an overview of contracting arrangements in agribusiness procurement practices in South Africa. The objective of this paper is to contribute to a better understanding of the structures and issues of raw commodity procurement in South African agribusiness supply chains. The results suggest that a wide range of institutions are employed to procure raw commodities for the South African agro-processing sector and that companies are increasingly moving away from the open market as a source of supply for raw commodities, and are utitising contractual arrangements instead. According to the main findings, 78.5% of the total volume of fruit and vegetables procured by agribusiness companies for processing is based on some form of contracting arrangement. The balance is procured through a combination of the open market, own estates, agents and imports. It is only in the case of potatoes, onions, beans and peanuts that a stronger reliance on the spot market is evident. South African retailers source 70% to 100% of their fresh produce directly from farmers (usually through growing programmes). The procurement of meat, poultry and eggs appears to favour vertical integration (and in some cases own production), medium- to long-term contracts and long-term 'informal' supply arrangements with selected groups of farmers. [ABSTRACT FROM AUTHOR]

The article discusses a search of randomized controlled trials (RCTs) on topical negative pressure (TNP) in adult patients with all kinds of wounds in all settings. Results reveal that in chronic and diabetic wounds, TNP failed to allow earlier complete wound healing. However, it was related to a 1-10 day reduction in the time needed to prepare the wound for secondary closure surgery. It is concluded that there is little evidence to support the use of TNP in wound treatment.

Aims and objectives. To study the material and nursing costs and outcome of wound care at home comparing two dressing groups (occlusive vs. gauze-based) in surgical patients after hospital dismissal. Background. The large variety in dressing materials and lack of convincing evidence make the choice for optimum local wound care at home cumbersome. Occlusive wound dressings require a lower change frequency than gauze-based dressings, which appears especially useful for homecare patients and could save costs. Methods. We investigated a consecutive series of 76 patients with wounds, included in a randomized trial comparing occlusive vs. gauze dressings. Daily dressing change frequency, consumption of dressing materials and need for district nursing visits were recorded until wound closure by means of diaries and at outpatient visits. Costs were expressed as means and 95% confidence intervals (CI) after calculation using non-parametric bootstrapping. Results. Patient groups were similar regarding age, wound size and aetiology. Dressing change frequency in the occlusive group (median: 0.6/day) was significantly (p = 0.008) lower than in the gauze group (1.1/day). Mean daily material costs of modern dressings were euro5.31 vs. euro0.71 in the gauze group. Mean difference; euro4.60 (95% CI, euro2.68-euro6.83) while daily total (material plus nursing) costs showed no difference between the groups; mean euro2.86 (95% CI, euro-6.50-euro10.25). Wound healing in the gauze-treated group tended to be quicker than in the occlusive dressing group (medians: 30 vs. 48 days, respectively; log-rank p = 0.060). Conclusions. The use of occlusive dressings does not lead to a reduction in costs and wound healing time as compared with gauze dressings for surgical patients receiving wound care at home. Relevance to clinical practice. District nurses should reconsider using gauze-based dressings, particularly in surgical patients with exudating wounds. [ABSTRACT FROM AUTHOR]

Nicotine Replacement Therapy (NRT) is the most frequently used pharmacological intervention for smoking cessation. Research on the effect of NRT showed serious nonadherence among users. We investigated adherence to NRT in cardiovascular patients. A number of 174 outpatients (N = 174), who smoked > 5 cigarettes a day, received free patches and intensive instructions from nurses. Questionnaires were sent to patients assessing patient characteristics, adherence to a 7-8 weeks time frame and appliance instructions, side effects/withdrawal symptoms, and reasons for nonadherence. Only 38% of the patients was adherent to the time frame. Appliance instructions were followed in 76-96% of the cases, except for smoking; 50% continued to smoke during NRT. In conclusion, despite considerable attention to appliance instructions, access to free patches and additional behavioral support, adherence to NRT in these patients is rather low. [ABSTRACT FROM AUTHOR]

The introduction of genetically modified (GM) food products to food markets around the world, has led to considerable controversy. In many cases consumer attitudes and perceptions of GM food products were revealed as fears, concern for, and avoidance of the new technology. The importance of GM foods in South Africa is increasing, even though the GM Food debate lags behind many other (often more developed) parts of the world. This paper investigates the knowledge, attitudes and acceptance of urban South African white-grain maize consumers regarding GM maize. Conjoint- and cluster analysis were used to develop clusters/market segments among the urban consumers of white maize. A range of additional questions was used to develop profiles of the identified market segments. These aspects covered demographics, GM knowledge aspects as well as GM attitude aspects. Four distinct clusters/market segments were identified with specific characteristics: "Anti-GM, Brand aware" cluster (35% of valid responses), "Brand unaware, Farmer sympathetic" cluster (20%), "GM consumer benefit, Brand aware" cluster (25%) and the "Brand aware, Pro-GM" cluster (20%). The most significant differences between the clusters were based on the consumers' attitudes towards GM food products. [ABSTRACT FROM AUTHOR]

Presents a systematic review and meta-analysis of controlled trials assessing spinal cord stimulation (SCS) for inoperable critical leg ischemia. Evidence showing that the addition of SCS to standard conservative treatment improves limb salvage, ischemic pain and general clinical situation in patients with inoperable chronic critical leg ischemia; Need for the benefits to be weighed against the cost and the complications associated with the technique.

Background/Aim: Transurethral catheterization is generally associated with a higher incidence of urinary tract infections than suprapubic catheterization; however, suprapubic catheterization is associated with other disadvantages such as higher costs and a more difficult technique, and at the moment there is no consensus about the use of both catheter systems. Therefore, a prospective randomized study was performed to investigate the effects of suprapubic catheterization and transurethral catheterization in patients undergoing surgery on the incidence of urinary tract infections and patient satisfaction. Methods: Patients who underwent an elective laparotomy were randomized and received a suprapubic or transurethral catheter. The primary end point was urinary tract infection. Other parameters of urinary tract infection, as well as duration of catheterization, hospital stay, and number of recatheterizations and of relaparotomies were monitored. Treatment 'per protocol' was also analyzed after exclusion of patients receiving another catheter than randomized for. Patients were asked for their satisfaction with the catheters and complaints during and after catheterization. Results: 165 patients were eligible, of whom 19 patients had to be excluded. 75 patients were allocated to receive the suprapubic catheter and 71 the transurethral catheter. There was no difference in the incidence of a urinary tract infection between the suprapubic group (n = 9/75; 12%) and the transurethral group (n = 8/71; 11%). Most patients (6/9) who developed a urinary tract infection in the suprapubic group, however, underwent recatheterization because of postoperative complications/sepsis and relaparotomy. The incidence of urinary tract infections in patients who received a suprapubic catheter and not a transurethral catheter was 3/59 (5%). The patients did not differ with respect to satisfaction and complaints. Being a men, recatheterization and duration of catheterization are risk factors. Conclusions: The incidence of a urinary tract infection between a suprapubic catheter and a transurethral catheter in patients undergoing major surgery was not different. A potential advantage of the suprapubic catheter (reduction of urinary tract infections) is probably partly negated, because transurethral catheters were used if recatheterization was indicated during the postoperative stay or due to complications. [ABSTRACT FROM AUTHOR]

Background: Urine of patients with urinary tract infection (UTI) contains high levels of interleukin (IL)-6 and IL-8. However, knowledge of the kinetics of their release in urine is limited. We therefore compared the appearance of IL-6 and IL-8 in urine after uncomplicated surgery and surgery complicated by UTI. Patients and Methods: 165 patients undergoing abdominal surgery who received a urinary catheter were studied. Urine IL-6 and IL-8 were prospectively measured in patients who did (n = 10) or did not (n = 20) develop UTI. Statistical. analysis was done by one-way ANOVA and the Mann-Whitney test. Results: Although urine IL-6 increased in the 2 to 4 days preceding the bacteriological, documentation of UTI, a similar increase was observed in patients who did not develop UTI. Urine IL-8 was elevated on the day UTI was diagnosed, while remaining low in controls. Conclusion: In this patient group with postoperative UTI, urine IL-8 was a better marker for the early host response than urine IL-6. [ABSTRACT FROM AUTHOR]

Copyright of Douleur et Analgésie is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The physician assistant (PA) and the nurse practitioner (NP) were introduced into The Netherlands in 2001 and 1997 respectively. By the second decade, national policies had accelerated the acceptance and development of these professions. Since 2015, the PA and NP have full practice authority as independent health professionals. The aim of this research was to gain a better understanding of the tasks and responsibilities that are being shifted from Medical Doctors (MD) to PAs and NPs in hospitals. More specifically in what context and visibility are these tasks undertaken by hospital-based PAs and NPs in patient care. This will enable them to communicate their worth to the hospital management.Study Design: A descriptive, non-experimental research method design was used to collect and analyze both quantitative and qualitative data about the type of tasks performed by a PA or NP. Fifteen medical departments across four hospitals participated.Methods: The patient scheduling system and hospital information system were probed to identify and characterize a wide variety of clinical tasks. The array of tasks was further verified by 108 interviews. All tasks were divided into direct and indirect patient care. Once the tasks were cataloged, then MDs and hospital managers graded the PA- or NP-performed tasks and assessed their contributions to the hospital management system.Findings: In total, 2883 tasks were assessed. Overall, PAs and NPs performed a wide variety of clinical and administrative tasks, which differed across hospitals and medical specialties. Data from interviews and the hospital management systems revealed that over a third of the tasks were not properly registered or attributed to the PA or NP. After correction, it was found that the NP and PA spent more than two thirds of their working time on direct patient care.Conclusions: NPs and PAs performed a wide variety of clinical tasks, and the consistency of these tasks differed per medical specialty. Despite the fact that a large part of the tasks was not visible due to incorrect administration, the interviews with MDs and managers revealed that the use of an NP or PA was considered to have an added value at the quality of care as well to the production for hospital-based medical care in The Netherlands. [ABSTRACT FROM AUTHOR]

Copyright of Huisarts En Wetenschap is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)