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Healthcare, Volume 7, Issue 4 (December 2019) – 54 articles

Cover Story (view full-size image): Increasing demands for high quality and safe patient care compel the need for competent healthcare professionals working in a collaborative team environment. Medical professionals are instrumental in leading the healthcare team; therefore, it is necessary to introduce interprofessional learning early in the medical curriculum. This exploratory study evaluated the perceptions of a sample of medical students undergoing training in the United States toward interprofessional education and collaboration in healthcare. The results reveal that medical students appreciate the importance of interprofessional education, embrace interprofessional learning, and welcome the opportunity to learn with other healthcare disciplines. Case studies and simulations were identified as potential methods to integrate with other healthcare disciplines. View this paper
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Open AccessArticle
Cancer Diagnosis Disclosure and Quality of Life in Elderly Cancer Patients
Healthcare 2019, 7(4), 163; https://doi.org/10.3390/healthcare7040163 - 14 Dec 2019
Viewed by 1727
Abstract
Informed consent and patient autonomy rights require an optimal cancer diagnosis disclosure strategy to be used to update the patients and caregivers with the bad news. However, a cancer diagnosis disclosure may arouse anxiety and distress which increase patients’ and caregivers’ psychological burden. [...] Read more.
Informed consent and patient autonomy rights require an optimal cancer diagnosis disclosure strategy to be used to update the patients and caregivers with the bad news. However, a cancer diagnosis disclosure may arouse anxiety and distress which increase patients’ and caregivers’ psychological burden. This study aims to explore the influence of cancer diagnosis disclosure on the quality of life in elderly cancer patients and their caregivers, and to introduce an effective way to disclose cancer diagnosis. A total of 120 participants were randomly selected in the study. The Medical Coping Modes Questionnaire was used to select informed person. The SPIKES was used to guide the disclosure procedures. The informed patients’ or caregivers’ quality of life were evaluated by the Generic Quality of Life Inventory-74 or Caregiver Quality of Life Scale before and after the cancer diagnosis disclosure and at the discharge time. After cancer diagnosis disclosure, no significant change was found on the quality of life of the informed person. With multiple psychological interventions implemented, a significant increase was noticed on the quality of life of the informed person. Applying the cancer diagnosis disclosure strategies and psychological intervention were essential to improve cancer patients’ and caregivers’ quality of life. Full article
Open AccessOpinion
The Preventive Effect of Dietary Antioxidants against Cervical Cancer versus the Promotive Effect of Tobacco Smoking
Healthcare 2019, 7(4), 162; https://doi.org/10.3390/healthcare7040162 - 13 Dec 2019
Cited by 1 | Viewed by 1671
Abstract
Uterine cervical cancer is the fourth most common cancer in women, and its etiology has been recognized. High-risk human papilloma virus (HR-HPV) infection induces an opportunity for malignant transformation. This paper discusses the current issues based on a review of the literature and [...] Read more.
Uterine cervical cancer is the fourth most common cancer in women, and its etiology has been recognized. High-risk human papilloma virus (HR-HPV) infection induces an opportunity for malignant transformation. This paper discusses the current issues based on a review of the literature and compares the impact of the dietary and nutrient intake to the impact of tobacco smoking on cervical cancer development. The important roles of diet/nutrition in cervical cancer are as prophylaxis against HR-HPV infection. Antioxidant vitamins can inhibit the proliferation of cancer cells, stabilize the p53 protein, prevent DNA damage, and reduce immunosuppression. In contrast, tobacco smoking not only causes DNA adducts and strand breaks, but it independently causes an increased viral load in HR-HPV-infected cells. Tobacco smoking induces the heightened expression of E6 and E7 and can inhibit the immune system response to HPV. What happens when two materials, which have opposite effects on cervical cells, are taken in at the same time? The negative effects of tobacco smoking may be stronger than the positive effects of vitamins, vegetables, and fruits on the regression of cervical disease such as cervical intraepithelial neoplasia (CIN). A relatively low intake of vitamins, vegetables, and fruits in combination with tobacco smoking was most associated with a high incidence of cervical neoplasia. Full article
(This article belongs to the Section Women Health)
Open AccessArticle
The Feasibility of Using N-Of-1 Trials to Investigate Deprescribing in Older Adults with Dementia: A Pilot Study
Healthcare 2019, 7(4), 161; https://doi.org/10.3390/healthcare7040161 - 12 Dec 2019
Cited by 1 | Viewed by 1799
Abstract
N-of-1 trials may provide insights into the impact of deprescribing medications in populations where evidence is currently lacking, such as the effect of statins on cognition in people with dementia. For this pilot, N-of-1, double-blinded, deprescribing trial, adults over 80 years of age [...] Read more.
N-of-1 trials may provide insights into the impact of deprescribing medications in populations where evidence is currently lacking, such as the effect of statins on cognition in people with dementia. For this pilot, N-of-1, double-blinded, deprescribing trial, adults over 80 years of age with dementia taking statins for at least 6-months were recruited from a hospital’s geriatric medicine outpatient clinic in Sydney, Australia. Participants discontinued and restarted statins over the study period. At enrolment, the hospital pharmacy—using a random number generator, randomised recruited participants to their usual statin or placebo regimen, with assessment and switching of treatment every 5 weeks from baseline (0-weeks) until Visit 4 (15-weeks). Primary outcome was measured using the rate of change in Alzheimer’s Disease Assessment Score-Cognitive Subscale (ADAS-CoG). Over 6-months, 81 participants were screened, 14 were eligible, and four were randomised. One participant (female, 88 years) completed all four assessments with no major harms reported. Cognitive impairment, as measured by ADAS-CoG score, was similar on placebo (15.5/70) compared to statin (15/70). This study suggests there are significant challenges in performing N-of-1 trials and recruiting people with dementia into deprescribing trials from outpatient settings. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
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Open AccessArticle
Rural Resident Experience on National Basic Public Health Services: A Cross-Sectional Survey in 10 Western Provinces of China
Healthcare 2019, 7(4), 160; https://doi.org/10.3390/healthcare7040160 - 07 Dec 2019
Cited by 1 | Viewed by 1449
Abstract
National basic public health services (BPHSs) are important for promoting the health of rural populations. A better understanding of rural BPHSs from the viewpoint of residents utilizing the services can help health-related departments and primary health care (PHC) centers further improve rural BPHSs. [...] Read more.
National basic public health services (BPHSs) are important for promoting the health of rural populations. A better understanding of rural BPHSs from the viewpoint of residents utilizing the services can help health-related departments and primary health care (PHC) centers further improve rural BPHSs. By conducting a large-scale cross-sectional survey in 10 western provinces of China, the study depicts rural resident experiences with rural BPHSs. Of the 9019 participants, 59.33% and 66.48% did not receive services related to health examinations or health education in the six months prior to the survey, respectively. A total of 56.90% were satisfied with the rural BPHSs, and the mean overall satisfaction score was 3.61 ± 0.908 (out of a maximum of 5). The most satisfying domain for rural residents with BPHSs was the attitude of PHC workers, whereas rural residents with chronic diseases were the least satisfied with the health management. Satisfaction with the attitude of PHC workers was identified as the strongest determinant of rural residents’ overall satisfaction with BPHSs. This study could enlighten rural BPHSs management in China. Full article
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Open AccessArticle
The Influence of Workplace Incivility on Employees’ Emotional Exhaustion in Recreational Sport/Fitness Clubs: A Cross-Level Analysis of the Links between Psychological Capital and Perceived Service Climate
Healthcare 2019, 7(4), 159; https://doi.org/10.3390/healthcare7040159 - 06 Dec 2019
Viewed by 1493
Abstract
The aim of this study was to explore the influence of workplace incivility on the emotional exhaustion of recreational sport/fitness club providers through a cross-level analysis. A total of 200 recreational sport/fitness club providers from Taiwan were selected for the repeated collection of [...] Read more.
The aim of this study was to explore the influence of workplace incivility on the emotional exhaustion of recreational sport/fitness club providers through a cross-level analysis. A total of 200 recreational sport/fitness club providers from Taiwan were selected for the repeated collection of measures and a 10-day diary method was used. The effect of workplace incivility on recreational sport/fitness club employees’ emotional exhaustion on a daily basis was analyzed at the intra-personal level, and the relationship between psychological capital and perceived service climate was studied at the inter-personal level. Five hypotheses were developed and tested using hierarchical linear modeling. The results found that employees’ emotional exhaustion and burnout highly correlated with workplace incivility and service climate. Based on the results, recommendations for employees and sport/fitness centers are proposed. Furthermore, research limitations and future directions are discussed. Full article
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Open AccessReview
Differential Diagnosis of Uterine Leiomyoma and Uterine Sarcoma Using Magnetic Resonance Images: A Literature Review
Healthcare 2019, 7(4), 158; https://doi.org/10.3390/healthcare7040158 - 05 Dec 2019
Cited by 4 | Viewed by 1677
Abstract
MRI plays an essential role in patients before treatment for uterine mesenchymal malignancies. Although MRI includes methods such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, the differentiation between uterine myoma and sarcoma always becomes problematic. The present paper discusses important findings to ensure [...] Read more.
MRI plays an essential role in patients before treatment for uterine mesenchymal malignancies. Although MRI includes methods such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, the differentiation between uterine myoma and sarcoma always becomes problematic. The present paper discusses important findings to ensure that sarcomas are not overlooked in magnetic resonance (MR) images, and we describe the update in the differentiation between uterine leiomyoma and sarcoma with recent reports. Full article
(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)
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Open AccessArticle
Factors Influencing Long-Term Care Service Needs among the Elderly Based on the Latest Anderson Model: A Case Study from the Middle and Upper Reaches of the Yangtze River
Healthcare 2019, 7(4), 157; https://doi.org/10.3390/healthcare7040157 - 03 Dec 2019
Cited by 7 | Viewed by 1707
Abstract
The rapid growth of population aging makes providing adequate long-term care (LTC) services for the elderly a serious social dilemma in China. Thus, it is necessary to carry out a theoretical discussion on the LTC service needs of the elderly and find out [...] Read more.
The rapid growth of population aging makes providing adequate long-term care (LTC) services for the elderly a serious social dilemma in China. Thus, it is necessary to carry out a theoretical discussion on the LTC service needs of the elderly and find out their influencing factors. With four regions of the middle and upper reaches of the Yangtze River as the sample case, this study aims to explore the factors that affect LTC service needs of the elderly in the frame of the latest Anderson Model, which added psychosocial factors to predisposing characteristics, enabling factors, and need factors in the old version. Some interesting results have been found, for example, self-image evaluation is composed of several factors such as general physical health, attitude towards life, or psychosocial states. Finally, sub-analyses—namely, by age, by gender, and by educational level—were carried out since the choice of different long-term care service patterns is related to different age/gender/education groups. Full article
(This article belongs to the Section Nursing)
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Open AccessArticle
What Motivates Chinese Young Adults to Use mHealth?
Healthcare 2019, 7(4), 156; https://doi.org/10.3390/healthcare7040156 - 02 Dec 2019
Cited by 2 | Viewed by 1795
Abstract
mHealth is one of China’s national strategies that brings affordable, accessible, and convenient health care to its entire population, may they be in cities or rural areas. Although Chinese young adults are among the first to adopt mHealth, the factors influencing Chinese young [...] Read more.
mHealth is one of China’s national strategies that brings affordable, accessible, and convenient health care to its entire population, may they be in cities or rural areas. Although Chinese young adults are among the first to adopt mHealth, the factors influencing Chinese young adults to use mHealth are yet to be studied both empirically and in depth. This study explores the mechanism that determines Chinese young adults’ intention to use mHealth, based on an extended Technology Acceptance Model (TAM). The extended TAM was tested using responses from 486 Chinese young adults. The results showed that perceived usefulness strongly and significantly influenced people’s intention to use mHealth. Additionally, communication effectiveness, health consciousness, and perceived ease of use were found as significant factors influencing people’s intention to use mHealth through perceived usefulness. Distrust was not found to significantly influence people’s intention to use mHealth. Full article
(This article belongs to the Section TeleHealth and Digital Healthcare)
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Open AccessArticle
Detection and Transstadial Passage of Babesia Species and Borrelia burgdorferi Sensu Lato in Ticks Collected from Avian and Mammalian Hosts in Canada
Healthcare 2019, 7(4), 155; https://doi.org/10.3390/healthcare7040155 - 02 Dec 2019
Cited by 3 | Viewed by 2400
Abstract
Lyme disease and human babesiosis are the most common tick-borne zoonoses in the Temperate Zone of North America. The number of infected patients has continued to rise globally, and these zoonoses pose a major healthcare threat. This tick-host-pathogen study was conducted to test [...] Read more.
Lyme disease and human babesiosis are the most common tick-borne zoonoses in the Temperate Zone of North America. The number of infected patients has continued to rise globally, and these zoonoses pose a major healthcare threat. This tick-host-pathogen study was conducted to test for infectious microbes associated with Lyme disease and human babesiosis in Canada. Using the flagellin (flaB) gene, three members of the Borrelia burgdorferi sensu lato (Bbsl) complex were detected, namely a Borrelia lanei-like spirochete, Borrelia burgdorferi sensu stricto (Bbss), and a distinct strain that may represent a separate Bbsl genospecies. This novel Bbsl strain was detected in a mouse tick, Ixodes muris, collected from a House Wren, Troglodytes aedon, in Quebec during the southward fall migration. The presence of Bbsl in bird-feeding larvae of I. muris suggests reservoir competency in three passerines (i.e., Common Yellowthroat, House Wren, Magnolia Warbler). Based on the 18S ribosomal RNA (rRNA) gene, three Babesia species (i.e., Babesia divergens-like, Babesia microti, Babesia odocoilei) were detected in field-collected ticks. Not only was B. odocoilei found in songbird-derived ticks, this piroplasm was apparent in adult questing blacklegged ticks, Ixodes scapularis, in southern Canada. By allowing live, engorged ticks to molt, we confirm the transstadial passage of Bbsl in I. muris and B. odocoilei in I. scapularis. Bbss and Babesia microti were detected concurrently in a groundhog tick, Ixodes cookei, in Western Ontario. In Alberta, a winter tick, Dermacentor albipictus, which was collected from a moose, Alces alces, tested positive for Bbss. Notably, a B. divergens-like piroplasm was detected in a rabbit tick, Haemaphysalis leporispalustris, collected from an eastern cottontail in southern Manitoba; this Babesia species is a first-time discovery in Canada. This rabbit tick was also co-infected with Borrelia lanei-like spirochetes, which constitutes a first in Canada. Overall, five ticks were concurrently infected with Babesia and Bbsl pathogens and, after the molt, could potentially co-infect humans. Notably, we provide the first authentic report of I. scapularis ticks co-infected with Bbsl and B. odocoilei in Canada. The full extent of infectious microorganisms transmitted to humans by ticks is not fully elucidated, and clinicians need to be aware of the complexity of these tick-transmitted enzootic agents on human health. Diagnosis and treatment must be administered by those with accredited medical training in tick-borne zoonosis. Full article
(This article belongs to the Special Issue Lyme Disease and Related Tickborne Infections)
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Open AccessArticle
Maternal Health and Green Spaces in China: A Longitudinal Analysis of MMR Based on Spatial Panel Model
Healthcare 2019, 7(4), 154; https://doi.org/10.3390/healthcare7040154 - 02 Dec 2019
Cited by 3 | Viewed by 1389
Abstract
The positive impact of green spaces on public health has attracted increasing attention, and maternal health has also been shown to be related to green spaces. However, there are different kinds of green space indicators that represent different mechanisms for mitigating maternal health, [...] Read more.
The positive impact of green spaces on public health has attracted increasing attention, and maternal health has also been shown to be related to green spaces. However, there are different kinds of green space indicators that represent different mechanisms for mitigating maternal health, and few studies have investigated the different relevance amongst them with longitudinal data. This study explores the correlation between various green space indicators and maternal health using spatial panel models with provincial data from China from 2007 to 2016. The results indicate that all kinds of green spaces could decrease maternal mortality, wherein public green spaces may play a key role. In terms of spatial correlation, an increase in green space coverage in adjacent provinces may also result in a slight decline in maternal mortality. This paper provides valuable insight into the correlation between maternal health and green spaces. Full article
(This article belongs to the Section Environmental Factors and Global Health)
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Open AccessArticle
Comparison between Conventional IMRT Planning and a Novel Real-Time Adaptive Planning Strategy in Hypofractionated Regimes for Prostate Cancer: A Proof-of-Concept Planning Study
Healthcare 2019, 7(4), 153; https://doi.org/10.3390/healthcare7040153 - 02 Dec 2019
Viewed by 1443
Abstract
In prostate cancer external beam radiation therapy (EBRT), intra-fraction prostate drifts may compromise the treatment efficacy by underdosing the target and/or overdosing the organs at risk. In this study, a recently developed real-time adaptive planning strategy for intensity-modulated radiation therapy (IMRT) for prostate [...] Read more.
In prostate cancer external beam radiation therapy (EBRT), intra-fraction prostate drifts may compromise the treatment efficacy by underdosing the target and/or overdosing the organs at risk. In this study, a recently developed real-time adaptive planning strategy for intensity-modulated radiation therapy (IMRT) for prostate cancer was evaluated in hypofractionated regimes against traditional treatment planning based on a treatment volume margin expansion. The proposed workflow makes use of a “library of plans” corresponding to possible intra-fraction prostate positions. During delivery, at each beam end, the plan prepared for the position of the prostate closest to the current one is selected and the corresponding beam delivered. This adaptive planning strategy was compared with the traditional approach on a clinical prostate cancer case where different prostate shift magnitudes were considered. Five, six and fifteen fraction hypofractionated schemes were considered for each of these scenarios. When shifts larger than the treatment margin were present, using the traditional approach the seminal vesicles were underdosed by 3–4% of the prescribed dose. The adaptive approach instead allowed for correct target dose coverage and lowered the dose on the rectum for each dosimetric endpoint on average by 3–4% in all the fractionation schemes. Standard intensity-modulated radiation therapy planning did not always guarantee a correct dose distribution on the seminal vesicles and the rectum. The adaptive planning strategy proposed resulted insensitive to the intra-fraction prostate drifts, produced a dose distribution in agreement with the dosimetric requirements in every case analysed and significantly lowered the dose on the rectum. Full article
(This article belongs to the Special Issue Radiotherapy and Cancer)
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Open AccessProject Report
Medication Error Rate in Transition of Care: General Practitioner (GP) Referrals to a Regional Emergency Department
Healthcare 2019, 7(4), 152; https://doi.org/10.3390/healthcare7040152 - 28 Nov 2019
Viewed by 1496
Abstract
Medication errors have a significant impact on patient outcomes, increase healthcare costs, and are a common cause of preventable morbidity. This single-site, observational, diagnostic accuracy study aimed to quantify medication discrepancies in transition of care from primary care to the emergency department (ED) [...] Read more.
Medication errors have a significant impact on patient outcomes, increase healthcare costs, and are a common cause of preventable morbidity. This single-site, observational, diagnostic accuracy study aimed to quantify medication discrepancies in transition of care from primary care to the emergency department (ED) over a 12-month period. Medication lists in General Practitioner (GP) referrals to a regional ED were examined against a Best Possible Medication History (BPMH) performed by a hospital pharmacist. One hundred and forty-three patients (25%) with computer-generated GP referrals to ED who were subsequently admitted to hospital had a BPMH taken; 135 (94%) of these had at least one medication discrepancy identified with a discrepancy rate of 67.18 discrepancies per 100 medications. Improving medication reconciliation in the community may reduce the burden associated with preventable medication errors. Whether this is achieved by more frequent GP-led medication review or community-based pharmacist medication review may depend on the community and available resources. Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
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Open AccessArticle
Nurse Prescribing-Readiness of Polish Nurses to Take on New Competencies—A Cross-Sectional Study
Healthcare 2019, 7(4), 151; https://doi.org/10.3390/healthcare7040151 - 21 Nov 2019
Viewed by 1417
Abstract
From January 2016, nurses in Poland received new competencies for prescribing. The work is the first in Poland to elaborate on the subject of nurses’ readiness to learn and develop in the context of new nursing rights regarding autonomous prescription of medication and [...] Read more.
From January 2016, nurses in Poland received new competencies for prescribing. The work is the first in Poland to elaborate on the subject of nurses’ readiness to learn and develop in the context of new nursing rights regarding autonomous prescription of medication and continuation of the prescription for medication. The aim of the study is to analyze the readiness of Polish nurses to learn and develop in the context of new competencies to write prescriptions. The research was conducted among 756 nurses. The standardized questionnaire (Readiness of Employees for Learning and Development) was used. For all subscales of readiness for learning and development, average scores prevailed. The readiness to write prescriptions was significantly related to the level of openness to changes in the work environment (A1 scale), self-evaluation of past educational development (C5 scale) and educational and professional goals alignment- employee and company (scale D2) and increasing the readiness of nurses to practice all of the aforementioned agents, in particular medical devices. The readiness of nurses to learn and develop at all levels of the subscales was on an average level. Younger nurses, with a shorter seniority, having higher education and additional qualifications had a higher readiness to prescribe medications and write prescriptions. The higher readiness for learning and development was matched by a greater readiness to prescribe. The results obtained can be used to plan training and courses, as well as to create special pro-development programs, which may increase the nurses’ involvement in personal and professional development. Full article
(This article belongs to the Section Nursing)
Open AccessArticle
Study on the Recognition of Exercise Intensity and Fatigue on Runners Based on Subjective and Objective Information
Healthcare 2019, 7(4), 150; https://doi.org/10.3390/healthcare7040150 - 20 Nov 2019
Viewed by 1427
Abstract
A running exhaustion experiment was used to explore the correlations between the time-frequency domain indexes extracted from the surface electromyography (EMG) signals of targeted muscles, heart rate and exercise intensity, and subjective fatigue. The study made further inquiry into the feasibility of reflecting [...] Read more.
A running exhaustion experiment was used to explore the correlations between the time-frequency domain indexes extracted from the surface electromyography (EMG) signals of targeted muscles, heart rate and exercise intensity, and subjective fatigue. The study made further inquiry into the feasibility of reflecting and evaluating the exercise intensity and fatigue effectively during running using physiological indexes, thus providing individualized guidance for running fitness. Twelve healthy men participated in a running exhaustion experiment with an incremental and constant load. The percentage of heart rate reserve (%HRR), mean power frequency (MPF) and root mean square (RMS) from surface EMG (sEMG) signals of the rectus femoris (RF), biceps femoris (BF), tibialis anterior muscle (TA), and the lateral head of gastrocnemius (GAL) were obtained in real-time. The data were processed and analyzed with the rating of perceived exertion (RPE) scale. The experimental results show that the MPF on all the muscles increased with time, but there was no significant correlation between MPF and RPE in both experiments. Additionally, there was no significant correlation between RMS and RPE of GAL and BF, but there was a negative correlation between RMS and RPE of RF. The correlation coefficient was lower in the constant load mode, with the value of only −0.301. The correlation between RMS and RPE of TA was opposite in both experiments. There was a significant linear correlation between %HRR and exercise intensity (r = 0.943). In the experiment, %HRR was significantly correlated with subjective exercise fatigue (r = 0.954). Based on the above results, the MPF and RMS indicators on the four targeted muscles could not conclusively identify fatigue of lower extremities during running. The %HRR could be used to identify exercise intensity and human fatigue during running and could be used as an indicator of recognizing fatigue and exercise intensity in runners. Full article
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Open AccessArticle
Nutritional Knowledge and Self-Reported Nutritional Practice against Malnutrition among Physicians in Jeddah, Saudi Arabia
Healthcare 2019, 7(4), 149; https://doi.org/10.3390/healthcare7040149 - 19 Nov 2019
Cited by 1 | Viewed by 1482
Abstract
The new era of healthcare emphasizes the integration of nutritional care into healthcare management to improve patient outcomes. Previous studies indicated that nutritional knowledge among physicians is insufficient. Thus far, only a limited number of studies have assessed nutritional knowledge among Saudi physicians, [...] Read more.
The new era of healthcare emphasizes the integration of nutritional care into healthcare management to improve patient outcomes. Previous studies indicated that nutritional knowledge among physicians is insufficient. Thus far, only a limited number of studies have assessed nutritional knowledge among Saudi physicians, without providing data regarding their views toward practice against malnutrition. Therefore, the aim of the present cross-sectional study was to address this knowledge gap among Saudi physicians in the hospitals of Jeddah, Saudi Arabia. A total of 117 physicians were recruited using a questionnaire to collect physician characteristics, nutritional knowledge, and knowledge and practice related to malnutrition. The mean nutritional knowledge scores were low (50%; SD: 24%). Saudi physicians scored high in questions related to the medical field; however, their knowledge related to nutrition topics was poor. The majority of Saudi physicians agreed that the nutritional management of malnourished patients was difficult at screening (79%), assessment (78%), and treatment (78%) stages. The self-assessed knowledge and interest of physicians toward malnutrition was modest, and they found the malnutrition management to be only moderately relevant to their work. Nutritional knowledge and practice against malnutrition among Saudi physicians is insufficient. Saudi physicians require proper education and training in nutrition. Full article
Open AccessArticle
Influence of Cardiorespiratory Clinical Placements on the Specialty Interest of Physiotherapy Students
Healthcare 2019, 7(4), 148; https://doi.org/10.3390/healthcare7040148 - 17 Nov 2019
Viewed by 1342
Abstract
Clinical placements are an important part of health students’ training. Whilst much value is placed on the clinical environment as a place to learn, there is a paucity of direct evidence about its effectiveness. The aim of this study was to compare the [...] Read more.
Clinical placements are an important part of health students’ training. Whilst much value is placed on the clinical environment as a place to learn, there is a paucity of direct evidence about its effectiveness. The aim of this study was to compare the competence, importance, and interest in cardiorespiratory physiotherapy of students before and after one month of clinical practice. A pre- and post-placement questionnaire about students’ interest in different physiotherapy subspecialties was used. The students with a cardiorespiratory clinical placement showed a significant change in their perception about the importance of the cardiorespiratory specialty (0.348 ± 1.01; p < 0.001), while no significant change was observed in the students without cardiorespiratory placement (−0.014 ± 0.825; p = 0.883). The presence or absence of clinical placements seems to have a definitive impact on students’ choice of a specialty. This implies the need for developing a set of clinical placements in all the subareas of physiotherapy in order to give undergraduate students the opportunity to make a better decision. Full article
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Open AccessArticle
Robot Helps When Robot Fits: Examining the Role of Baby Robots in Fertility Promotion
Healthcare 2019, 7(4), 147; https://doi.org/10.3390/healthcare7040147 - 15 Nov 2019
Cited by 1 | Viewed by 1431
Abstract
Considering China is facing a precipitous decline in its population, there is an emerging trend of developing baby robots to encourage people’s willingness to become “parents”. Based on the decomposed theory of planned behavior and the theory of uncanny valley, this study empirically [...] Read more.
Considering China is facing a precipitous decline in its population, there is an emerging trend of developing baby robots to encourage people’s willingness to become “parents”. Based on the decomposed theory of planned behavior and the theory of uncanny valley, this study empirically investigated whether a baby robot could perform as a prominent antecedent of fertility intention in China, and how this relates to its visual appearance. Consistent with prior research, the current study used a between-subjects design to show (1) a baby robot could significantly improve people’s fertility attitude through temporal visual stimulation; (2) fertility attitude, subjective norms from peers, and perceived behavioral control of finance could significantly contribute to fertility intention. Theoretical contributions and implications are discussed in this study. Full article
(This article belongs to the Special Issue Mobile Health Care with Smart Technology Applications)
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Open AccessArticle
AR-Therapist: Design and Simulation of an AR-Game Environment as a CBT for Patients with ADHD
Healthcare 2019, 7(4), 146; https://doi.org/10.3390/healthcare7040146 - 15 Nov 2019
Cited by 1 | Viewed by 1813
Abstract
Attention Deficit Hyperactivity Disorder is one of the most common neurodevelopmental disorders in which patients have difficulties related to inattention, hyperactivity, and impulsivity. Those patients are in need of a psychological therapy use Cognitive Behavioral Therapy (CBT) to enhance the way they think [...] Read more.
Attention Deficit Hyperactivity Disorder is one of the most common neurodevelopmental disorders in which patients have difficulties related to inattention, hyperactivity, and impulsivity. Those patients are in need of a psychological therapy use Cognitive Behavioral Therapy (CBT) to enhance the way they think and behave. This type of therapy is mostly common in treating patients with anxiety and depression but also is useful in treating autism, obsessive compulsive disorder and post-traumatic stress disorder. A major limitation of traditional CBT is that therapists may face difficulty in optimizing patients’ neuropsychological stimulus following a specified treatment plan. Other limitations include availability, accessibility and level-of-experience of the therapists. Hence, this paper aims to design and simulate a generic cognitive model that can be used as an appropriate alternative treatment to traditional CBT, we term as “AR-Therapist.” This model takes advantage of the current developments of augmented reality to engage patients in both real and virtual game-based environments. Full article
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Open AccessArticle
Clinical Determinants Affecting Indications for Surgery and Chemotherapy in Recurrent Ovarian Granulosa Cell Tumor
Healthcare 2019, 7(4), 145; https://doi.org/10.3390/healthcare7040145 - 14 Nov 2019
Cited by 1 | Viewed by 1812
Abstract
Background: Because reports on the management of recurrent granulosa cell tumor have been sparse, a consensus as to which patients should undergo surgical resection and which patients should be considered for chemotherapy has not been established. Methods: A total of 21 tumor recurrences [...] Read more.
Background: Because reports on the management of recurrent granulosa cell tumor have been sparse, a consensus as to which patients should undergo surgical resection and which patients should be considered for chemotherapy has not been established. Methods: A total of 21 tumor recurrences in eight patients with granulosa cell tumor were reviewed. Results: Surgery was performed as the main treatment for 13 recurrences, while chemotherapy was chosen as the main treatment for eight recurrences. Complete tumor resection could be accomplished in 13 of 16 surgeries (81.3%), which include all the ten recurrences without involvement of liver or diaphragm and without ascites. The number of recurrent masses was significantly higher in the early recurrence group (progression free survival < 2 years) than in the late recurrence (progression free survival > 2 years). All cases with a solitary recurrent tumor at an extra-peritoneal site presented a significantly longer progression free survival. Conclusions: For patients with recurrent granulosa cell tumor, surgery may provide the best disease control. In cases with complete resection, the number of recurrent masses was the predictive factor for the next recurrence, and adjuvant chemotherapy might be considered in such cases. Full article
(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)
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Open AccessArticle
Impact of Media Reports and Environmental Pollution on Health and Health Expenditure Efficiency
Healthcare 2019, 7(4), 144; https://doi.org/10.3390/healthcare7040144 - 13 Nov 2019
Viewed by 1443
Abstract
Over the past few decades, China’s rapid economic, energy, and industrial developments have caused serious environmental damage. However, as there are large resource, energy use, economic, and environmental damage differences across Chinese regions, the Chinese government is seeking to reduce city pollution across [...] Read more.
Over the past few decades, China’s rapid economic, energy, and industrial developments have caused serious environmental damage. However, as there are large resource, energy use, economic, and environmental damage differences across Chinese regions, the Chinese government is seeking to reduce city pollution across the country. Most previous analyses have only looked at these issues on a single level; for example, the impact of environmental pollution on health, or energy and environmental efficiency analyses, but there have been few studies that have conducted overall analyses. Further, many of the methods that have been used in previous research have employed one-stage radial or non-radial analyses without considering regional differences. Therefore, this paper developed a meta undesirable two-stage EBM DEA model to analyze the energy, environment, health, and media communication efficiencies in 31 Chinese cities, from which it was found that the productivity efficiency in most cities was better than the health treatment efficiencies, the GDP and fixed asset efficiency improvements were small, the air quality index (AQI) and CO2 efficiencies varied widely between the cities, media report and governance inputs were generally inefficient, the birth rate efficiencies were better than the respiratory disease efficiencies, and the technical gap was best in Guangzhou, Shanghai, and Lhasa. Also, it found that high-income cities have a higher technology gap than upper middle–income cities, and media reports efficiency have a high correlation with respiratory diseases and CO2. Full article
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Open AccessArticle
Randomized Single-Case Experimental Designs in Healthcare Research: What, Why, and How?
Healthcare 2019, 7(4), 143; https://doi.org/10.3390/healthcare7040143 - 13 Nov 2019
Cited by 1 | Viewed by 1656
Abstract
Health problems are often idiosyncratic in nature and therefore require individualized diagnosis and treatment. In this paper, we show how single-case experimental designs (SCEDs) can meet the requirement to find and evaluate individually tailored treatments. We give a basic introduction to the methodology [...] Read more.
Health problems are often idiosyncratic in nature and therefore require individualized diagnosis and treatment. In this paper, we show how single-case experimental designs (SCEDs) can meet the requirement to find and evaluate individually tailored treatments. We give a basic introduction to the methodology of SCEDs and provide an overview of the available design options. For each design, we show how an element of randomization can be incorporated to increase the internal and statistical conclusion validity and how the obtained data can be analyzed using visual tools, effect size measures, and randomization inference. We illustrate each design and data analysis technique using applied data sets from the healthcare literature. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
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Open AccessArticle
Establishing and Sustaining a Culture of Evidence-Based Practice: An Evaluation of Barriers and Facilitators to Implementing the Best Practice Spotlight Organization Program in the Australian Healthcare Context
Healthcare 2019, 7(4), 142; https://doi.org/10.3390/healthcare7040142 - 12 Nov 2019
Cited by 1 | Viewed by 2082
Abstract
Background: Nurses and midwives are central to the implementation and delivery of quality care through evidence-based practice (EBP). However, implementation of EBP in nursing and midwifery is under-researched with few examples of systematic and sustained change. The Registered Nurses Association of Ontario’s Best-Practice [...] Read more.
Background: Nurses and midwives are central to the implementation and delivery of quality care through evidence-based practice (EBP). However, implementation of EBP in nursing and midwifery is under-researched with few examples of systematic and sustained change. The Registered Nurses Association of Ontario’s Best-Practice Spotlight Organization (BPSO) Program was adopted in South Australia as a framework to systematically implement EBP in two diverse and complex healthcare settings. Methods: The study was a post-implementation, mixed-method evaluation conducted at two healthcare settings in Adelaide, South Australia utilizing qualitative and quantitative data. Proctor’s implementation evaluation framework guided the evaluation design. Information sources included; interviews, focus groups, questionnaires, and document review. Results: Clinical and executive staff (n = 109 participants) from a broad range of stakeholder groups participated in the interviews, focus groups, and returned questionnaires. A number of facilitators directly affecting program implementation were identified; these pertained to embedding continuity into the program’s implementation and delivery, a robust governance structure, and executive sponsorship. Barriers to implementation were also identified. These barriers pertained to organizational or workforce challenges; staff turnover and movement (e.g., secondment), insufficient staff to allow people to attend training, and a lack of organizational commitment to the program, especially at an executive level. As a result of successful implementation, it was observed that over three years, the BPSO program positively influenced the uptake and implementation of EBP by clinicians and the organizations into which they were introduced. Conclusions: The BPSO model can be translocated to new healthcare systems and has the potential to act as a mechanism for establishing and sustaining EBP change. This study was the first to apply an implementation evaluation framework to the BPSO program, which allowed for structured analysis of facilitating or impeding factors that affected implementation success. The findings have important implications for other health systems looking to translocate the same or similar EBP programs, as well as contributing to the growing body of implementation evaluation literature. Full article
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Open AccessReview
Oral Appliances in Obstructive Sleep Apnea
Healthcare 2019, 7(4), 141; https://doi.org/10.3390/healthcare7040141 - 08 Nov 2019
Cited by 2 | Viewed by 1939
Abstract
Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive [...] Read more.
Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness. Full article
(This article belongs to the Special Issue Management of Obstructive Sleep Apnoea)
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Open AccessArticle
Parental Influence in Forming Preschool Children’s Eating Behaviors—A Cross-Sectional Survey in Chongqing, China
Healthcare 2019, 7(4), 140; https://doi.org/10.3390/healthcare7040140 - 07 Nov 2019
Cited by 2 | Viewed by 1389
Abstract
Children’s eating habits are closely related to their health problems and the outlook for children’s nutritional statuses appears poor. A cross-sectional survey was conducted among parents of preschool children from December 2018 to January 2019. Sixteen representative kindergartens in 6 districts of Chongqing, [...] Read more.
Children’s eating habits are closely related to their health problems and the outlook for children’s nutritional statuses appears poor. A cross-sectional survey was conducted among parents of preschool children from December 2018 to January 2019. Sixteen representative kindergartens in 6 districts of Chongqing, China, were included in the study. We took 2200 samples and collected information by questionnaire and after screening, 1781 questionnaires were valid and finally included in the data analysis (n = 1781). Ordinal logistic regression analysis found that age, fathers’ education level, forced diet and perception of children’s body shape were factors associated with children’s eating behaviors (ordered logistic regression/three-level eating behavior; odds ratios p < 0.05). 80.24% of preschool children may have unhealthy eating behavior in this survey and 80.35% of parents had forced their children to eat. Eating behaviors of preschool children in Chongqing are closely related to family factors. This study provides important insight for parents and health care workers in China to improve preschool-aged children’s nutritional behaviors. Intervention programs should focus on parents with low income, low education levels, coercive dietary behaviors and deviated body shape perceptions to reduce children’s eating behavioral problems. Full article
Open AccessArticle
On the Suitability and Potential of Nursing Care Discussion Forums as a Health Promotion Measure for Long-Distance Caregiving Relatives: Evidence from Upper Austria
Healthcare 2019, 7(4), 139; https://doi.org/10.3390/healthcare7040139 - 07 Nov 2019
Cited by 1 | Viewed by 1777
Abstract
Background: The number of persons who have to overcome extensive geographical distances for caring for their older parent(s), hereinafter referred to as long-distance caregiving relatives (LDCs), is rising. However, in the non-English-speaking Global North, little is known about the LDCs’ health literacy [...] Read more.
Background: The number of persons who have to overcome extensive geographical distances for caring for their older parent(s), hereinafter referred to as long-distance caregiving relatives (LDCs), is rising. However, in the non-English-speaking Global North, little is known about the LDCs’ health literacy and the design of tailor-made health promotion measures for this target-group. Using the example of nursing care discussion forums (NCDF), this paper reflects the requirements and (future) potential of professionally-lead support groups for LDCs on the case-study example of Upper Austria. Methods: In order to approach this unexplored topic considering spatial-related aspects, a qualitative-explorative study design was chosen, focusing on the providers’ perspective. A written survey among all NCDF-group leaders was carried out. Results: LDCs do not make use of NCDFs at present. It is considered that this is above all for time constraints, lack of information and location-based problems of fit. This applies for urban as well as rural contexts. Conclusions: LDCs need more attention in public health. Suitable NCDFs have to be located in the LCDs’ residential municipalities and have to fulfill different requirements from those of local caregiving relatives, particularly with regard to purpose and scope. Full article
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Open AccessArticle
Dynamic Linkages among Economic Development, Energy Consumption, Environment and Health Sustainable in EU and Non-EU Countries
Healthcare 2019, 7(4), 138; https://doi.org/10.3390/healthcare7040138 - 06 Nov 2019
Cited by 6 | Viewed by 1394
Abstract
There is a close and important relationship between environmental pollution and public health, and environmental pollution has an important impact on the public health. This study employed the two-stage meta-frontier dynamic network data envelopment analysis (TMDN-DEA) model to explore the environment pollution effects [...] Read more.
There is a close and important relationship between environmental pollution and public health, and environmental pollution has an important impact on the public health. This study employed the two-stage meta-frontier dynamic network data envelopment analysis (TMDN-DEA) model to explore the environment pollution effects from energy consumption on the mortality of children and adult, tuberculosis rate, survival rate and health expenditure efficiencies in 28 EU countries and 53 non-EU countries from 2010 to 2014. We calculated the overall efficiency scores and the technology gap ratios of each EU and non-EU countries and the efficiencies of input and output variables in the production and health stage. The average overall efficiencies each year in EU countries are higher than in the non-EU countries. But EU countries have higher energy efficiency than non-EU countries, and non-EU countries have higher health efficiency than EU countries. The health expenditure efficiencies in the EU countries are obviously lower than those in non-EU countries. The renewable energy efficiencies are obviously higher than the non-renewable energy efficiencies; PM2.5 efficiencies are obviously higher than the CO2 efficiencies and the children’s mortality rate efficiencies are higher than the adult’s mortality rate efficiencies for EU countries and non-EU countries. The government management in the EU and non-EU countries should be strengthened to reduce the air pollutant and carbon dioxide emissions and raise energy transformation to the clean energy in renewable energy and improve health efficiencies in medical and health care field. Full article
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Open AccessArticle
Comparison of Aggregated N-of-1 Trials with Parallel and Crossover Randomized Controlled Trials Using Simulation Studies
Healthcare 2019, 7(4), 137; https://doi.org/10.3390/healthcare7040137 - 06 Nov 2019
Cited by 3 | Viewed by 1881
Abstract
Background: N-of-1 trials offer an innovative approach to delivering personalized clinical care together with population-level research. While increasingly used, these methods have raised some statistical concerns in the healthcare community. Methods: We discuss concerns of selection bias, carryover effects from treatment, and trial [...] Read more.
Background: N-of-1 trials offer an innovative approach to delivering personalized clinical care together with population-level research. While increasingly used, these methods have raised some statistical concerns in the healthcare community. Methods: We discuss concerns of selection bias, carryover effects from treatment, and trial data analysis conceptually, then rigorously evaluate concerns of effect sizes, power and sample size through simulation study. Four variance structures for patient heterogeneity and model error are considered in a series of 5000 simulated trials with 3 cycles, which compare aggregated N-of-1 trials to parallel randomized controlled trials (RCTs) and crossover trials. Results: Aggregated N-of-1 trials outperformed both traditional parallel RCT and crossover designs when these trial designs were simulated in terms of power and required sample size to obtain a given power. N-of-1 designs resulted in a higher type-I error probability than parallel RCT and cross over designs when moderate-to-strong carryover effects were not considered or in the presence of modeled selection bias. However, N-of-1 designs allowed better estimation of patient-level random effects. These results reinforce the need to account for these factors when planning N-of-1 trials. Conclusion: N-of-1 trial designs offer a rigorous method for advancing personalized medicine and healthcare with the potential to minimize costs and resources. Interventions can be tested with adequate power with far fewer patients than traditional RCT and crossover designs. Operating characteristics compare favorably to both traditional RCT and crossover designs. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
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Open AccessProtocol
N-of-1 Trials as a Decision Support Tool in Clinical Practice: A Protocol for a Systematic Literature Review and Narrative Synthesis
Healthcare 2019, 7(4), 136; https://doi.org/10.3390/healthcare7040136 - 06 Nov 2019
Cited by 1 | Viewed by 1476
Abstract
The n-of-1 trial can utilized in clinical practice as a decision support tool, which may improve patient outcomes by providing both the patient and the clinician with objective evidence to inform personalized treatment decisions. As its use broadens, it will be important to [...] Read more.
The n-of-1 trial can utilized in clinical practice as a decision support tool, which may improve patient outcomes by providing both the patient and the clinician with objective evidence to inform personalized treatment decisions. As its use broadens, it will be important to study whether the added time and effort of an n-of-1 trial results in measurable improvements in important patient outcomes compared to usual clinical practice. Parallel-group randomized clinical trials testing the n-of-1 approach versus usual care have been undertaken in a number of medical settings. A systematic review will be performed according to PRISMA guidelines, using MEDLINE, Embase, Cochrane, CINAHL, PsycINFO, Scopus, and Web of Science to search for randomized clinical trials in humans, without date or language restriction. Reports from the gray literature and ongoing studies in trial registries will be included. Articles will be screened by two independent reviewers with a third reviewer consulted to adjudicate disagreement. The quality of included studies will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias. A narrative synthesis will explore the differing methodological approaches of the included studies. The protocol will be registered in the PROSPERO registry, and the results of the review will be published in a peer-reviewed journal. To our knowledge, this systematic review will be the first to comprehensively assess the existing research on randomized trials testing the n-of-1 trial approach in clinical practice. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
Open AccessArticle
Education and Protein Supplementation Improve Nutritional Biomarkers among Hypoalbuminemic Peritoneal Dialysis Patients: A Quasi-Experimental Design
Healthcare 2019, 7(4), 135; https://doi.org/10.3390/healthcare7040135 - 05 Nov 2019
Viewed by 1608
Abstract
Protein-energy wasting is prevalent in peritoneal dialysis patients, which causes a heavy burden for individuals and healthcare systems. We aimed to investigate the effect of nutritional education, and/or protein supplementation on nutritional biomarkers in hypoalbuminemic peritoneal dialysis patients. A quasi-experimental study was conducted [...] Read more.
Protein-energy wasting is prevalent in peritoneal dialysis patients, which causes a heavy burden for individuals and healthcare systems. We aimed to investigate the effect of nutritional education, and/or protein supplementation on nutritional biomarkers in hypoalbuminemic peritoneal dialysis patients. A quasi-experimental study was conducted in two dialysis centers at Taipei Tzu Chi Hospital and Shin Kong Wu Ho-Su Memorial Hospital. Patients were allocated in three groups including control (n = 12), milk protein (n = 21) and soy protein (n = 20). All patients received dietary guidelines from dietitians and completed 3-day dietary records during monthly visits for consecutive three months. Nutrients were analyzed using Nutritionist Professional software. Blood urea nitrogen (BUN), creatinine, albumin, total protein, hemoglobin, serum calcium, phosphorus, sodium, and potassium were assessed monthly. Total cholesterol and triglycerides were measured every three months. After three-month intervention, protein intake (percent of total calories), and serum albumin were significantly increased in three groups. Protein, phosphorus intake, and BUN were increased in two intervention groups. Total serum protein increased in control and milk protein groups, and creatinine increased the control group. Serum phosphorus was not significantly changed. Nutritional education alone, or combined with protein supplementation, significantly improve protein intake, and nutritional status by increasing serum albumin, but not serum phosphorus in hypoalbuminemic peritoneal dialysis patients. Full article
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Open AccessDiscussion
Personalised Medicine Using N-of-1 Trials: Overcoming Barriers to Delivery
Healthcare 2019, 7(4), 134; https://doi.org/10.3390/healthcare7040134 - 05 Nov 2019
Viewed by 1820
Abstract
In this paper we discuss the value of N-of-1 trials in personalising health care. We describe the challenges faced in implementing N-of-1 trials in the United Kingdom’s National Health Service and suggest how making greater use of these personalised trials might be facilitated. [...] Read more.
In this paper we discuss the value of N-of-1 trials in personalising health care. We describe the challenges faced in implementing N-of-1 trials in the United Kingdom’s National Health Service and suggest how making greater use of these personalised trials might be facilitated. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
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