The rationale of our study was that the World Health Organization's (WHO) definition of health from 1947 which includes "… complete physical, mental and social wellbeing…" does not fit the current ...societal viewpoints anymore. The WHO's definition of health implies that many people with chronic illnesses or disabilities would be considered unhealthy and complete wellbeing would be utopian and unfeasible for them. This is no longer uniformly accepted. Many alternative concepts of health have been discussed in the last decades such as 'positive health', which focusses on someone's capability rather than incapability,. However, the question remains whether a general health concept can guide all healthcare practices. More likely, health concepts need to be specified for professions or settings. The objective of our study was to create a structured overview of published concepts of health from different perspectives by conducting a scoping review using the PRISMA-ScR guideline. A literature search was conducted in Pubmed and Cinahl. Articles eligible for inclusion focussed on the discussion or the conceptualisation of health or health-related concepts in different contexts (such as the perspective of care workers' or patients') published since 2009 (the Dutch Health Council raised the discussion about moving towards a more dynamic perspective on health in that year). Seventy-five articles could be included for thematic analyses. The results showed that most articles described a concept of health consisting of multiple subthemes; no consensus was found on one overall concept of health. This implies that healthcare consumers act based on different health concepts when seeking care than care workers when providing care. Having different understandings of the concepts of health can lead to misunderstandings in practice. In conclusion, from every perspective, and even for every individual, health may mean something different. This finding stresses the importance that care workers' and healthcare consumers' meaning of 'health' has to be clear to all actors involved. Our review supports a more uniform tuning of healthcare between healthcare providers (the organisations), care workers (the professionals) and healthcare consumers (the patients), by creating more awareness of the differences among these actors, which can be a guide in their communication.
Today's healthcare provision is facing several challenges, that cause the level of complexity to increase at a greater rate than the managerial capacity to effectively deal with it. One of these ...challenges is the demand for person-centered care in an approach that is tuned towards shared decision-making. Flexibility is needed to adequately respond to individual needs.
We elaborate on the potential of service modularity as a foundation for person-centered care delivered in a shared decision-making context, and examine to what extent this can improve healthcare. We primarily focused on theory building. To support our effort and gain insight into how service modularity is currently discussed and applied in healthcare, we conducted a scoping review.
Descriptions of actual implementations of modularity in healthcare are rare. Nevertheless, applying a modular perspective can be beneficial to healthcare service improvement since those service modularity principles that are still missing can often be fulfilled relatively easily to improve healthcare practice. Service modularity offers a way towards flexible configuration of services, facilitating the composition of tailored service packages. Moreover, it can help to provide insight into the possibilities of care for both healthcare professionals and patients.
We argue that applying a modular frame to healthcare services can contribute to individualized, holistic care provision and can benefit person-centered care. Furthermore, insight into the possibilities of care can help patients express their preferences, increasing their ability to actively participate in a shared decision-making process. Nevertheless, it remains essential that the healthcare professional actively collaborates with the patient in composing the care package, for which we propose a model. Altogether, we posit this can improve healthcare practice, especially for the people receiving care.
More than 60 species of medicinal plants belong to the genus Angelica (Family: Apiaceae). Many of these species have long been used in ancient traditional medicine systems, especially in the ...far-east. Various herbal preparations containing Angelica species are available over-the-counter, not only in the far-eastern countries, but also in the western countries like USA, UK, Germany, etc. For centuries, many species of this genus, e.g. A. acutiloba, A. archangelica, A. atropupurea, A. dahurica, A. japonica, A. glauca, A. gigas, A. koreana, A. sinensis, A. sylvestris, etc., have been used traditionally as anti-inflammatory, diuretic, expectorant and diaphoretic, and remedy for colds, flu, influenza, hepatitis, arthritis, indigestion, coughs, chronic bronchitis, pleurisy, typhoid, headaches, wind, fever, colic, travel sickness, rheumatism, bacterial and fungal infections and diseases of the urinary organs. Active principles isolated from these plants mainly include various types of coumarins, acetylenic compounds, chalcones, sesquiterpenes and polysaccharides. This review evaluates the importance of the genus Angelica in relation to its traditional medicinal uses, alternative medicinal uses in the modern society and potential for drug development, and summarises results of various scientific studies on Angelica species or Angelica-containing preparations for their bioactivities including, antimicrobial, anticancer, antitumour, analgesic, anti-inflammatory, hepatoprotective, nephroprotective, etc.
The properties of heavy-ion-acoustic (HIA) solitary structures associated with the nonlinear propagation of cylindrical and spherical electrostatic perturbations in an unmagnetized, collisionless ...dense plasma system has been investigated theoretically. Our considered model contains degenerate electron and inertial light ion fluids, and positively charged static heavy ions, which is valid for both of the non-relativistic and ultra-relativistic limits. The Korteweg-de Vries (K-dV) and modified K-dV (mK-dV) equations have been derived by employing the reductive perturbation method, and numerically examined in order. It has been found that the effect of degenerate pressure and number density of electron and inertial light ion fluids, and positively charged static heavy ions significantly modify the basic features of HIA solitary waves. It is also noted that the inertial light ion fluid is the source of dispersion for HIA waves and is responsible for the formation of solitary waves. The basic features and the underlying physics of HIA solitary waves, which are relevant to some astrophysical compact objects, are briefly discussed.
Abstract
Background
Treatment of opiate addiction with opiate substitution treatment (e.g. methadone) is beneficial. However, some individuals desire or would benefit from abstinence but there are ...limited options to attenuate problems with opiate withdrawal. Preclinical and preliminary clinical evidence suggests that the GABA-B agonist, baclofen, has the desired properties to facilitate opiate detoxification and prevent relapse. This study aims to understand whether there are any safety issues in administering baclofen to opioid-dependent individuals receiving methadone.
Methods
Opiate-dependent individuals (DSM-5 severe opioid use disorder) maintained on methadone will be recruited from addiction services in northwest London (NHS and third sector providers). Participants will be medically healthy with no severe chronic obstructive pulmonary disease or type 2 respiratory failure, no current dependence on other substances (excluding nicotine), no current severe DSM-5 psychiatric disorders, and no contraindications for baclofen or 4800 IU vitamin D (placebo). Eligible participants will be randomised in a 3:1 ratio to receive baclofen or placebo in an adaptive, single-blind, ascending dose design. A Bayesian dose-escalation model will inform the baclofen dose (10, 30, 60, or 90 mg) based on the incidence of ‘dose-limiting toxicity’ (DLT) events and participant-specific methadone dose. A range of respiratory, cardiovascular, and sedative measures including the National Early Warning Score (NEWS2) and Glasgow Coma Scale will determine DLT. On the experimental day, participants will consume their usual daily dose of methadone followed by an acute dose of baclofen or placebo (vitamin D3) ~ 1 h later. Measures including oxygen saturation, transcutaneous CO
2
, respiratory rate, QTc interval, subjective effects (sedation, drug liking, craving), plasma levels (baclofen, methadone), and adverse events will be obtained using validated questionnaires and examinations periodically for 5 h after dosing.
Discussion
Study outcomes will determine what dose of baclofen is safe to prescribe to those receiving methadone, to inform a subsequent proof-of-concept trial of the efficacy baclofen to facilitate opiate detoxification. To proceed, the minimum acceptable dose is 30 mg of baclofen in patients receiving ≤ 60 mg/day methadone based on the clinical experience of baclofen’s use in alcoholism and guidelines for the management of opiate dependence.
Trial registration
Clinicaltrials.gov NCT05161351. Registered on 16 December 2021.
The coronavirus (COVID-19) has affected millions of people around the world. COVID-19 patients, particularly those with the critical illness, have coagulation abnormalities, thrombocytopenia, and a ...high prevalence of intravascular thrombosis.
This work aims to assess the prevalence of coagulation disorders and their related symptoms among COVID-19 patients in the Al-Jouf region of Saudi Arabia.
We conducted a retrospective study on 160 COVID-19 patients. Data were collected from the medical records department of King Abdulaziz Specialist Hospital, Sakaka, Al-Jouf, Saudi Arabia. The socio-demographic data, risk factors, coagulation profile investigation results, symptom and sign data related to coagulation disorders, and disease morbidity and mortality for COVID-19 patients were extracted from medical records, and the data were stored confidentially.
Males represented the highest prevalence of COVID-19 infection at 65%; 29% were aged 60 or over; 28% were smokers; and 36% were suffering from chronic diseases, with diabetes mellitus representing the highest prevalence. Positive D-dimer results occurred in 29% of cases, with abnormal platelet counts in 26%.
Our findings confirm that the dysregulation of the coagulation cascade and the subsequent occurrence of coagulation disorders are common in coronavirus infections. The results show absolute values, not increases over normal values; thus, it is hard to justify increased risk and presence based on the presented data.
Up to 50% of the patients experience complications after colorectal cancer (CRC) surgery. Improved preoperative physical and nutritional status can enhance clinical outcomes and reduce postoperative ...complications. This retrospective, single-center, observational cohort study assessed the impact of a four-week multimodal prehabilitation program on postoperative complications, unplanned readmissions, length of stay, and mortality in elective high-risk CRC patients.
Elective high-risk CRC patients, defined as ASA ≥3 or ≥65yr, who attended the multimodal prehabilitation program (prehabilitation-group) were compared to a historical cohort receiving standard care (control-group). Differences in outcomes between these groups were tested using Fisher's Exact and Mann-Whitney U test. To adjust for confounding, multivariate logistic regression analysis was performed. The main study outcome was the occurrence of postoperative complications. Secondary outcomes included unplanned readmissions, length of hospital stay, and mortality.
351 patients were included (n = 275 control-group, n = 76 prehabilitation-group). The complication rate was lower in the prehabilitation group compared to the control group, 26.3% (n = 20) versus 40% (n = 110) (p = .032). There were fewer unplanned readmissions in the prehabilitation group compared to the control group, 5.3% (n = 4) versus 16.4% (n = 45), p = .014. Median hospital days of stay was 1 day shorter for the prehabilitation-group (p = .004), mortality did not significantly differ between the groups.
This study shows that the used multimodal prehabilitation program leads to a reduction of medical postoperative complications, unplanned readmissions, and shortens the median hospital stay compared with standard care in high-risk CRC patients undergoing elective CRC surgery.
•Surgery is the only curative treatment for colorectal cancer, however, complications occur in up to 50% of all patients.•Multimodal prehabilitation program lead to a reduction of postoperative medical complications, unplanned readmissions and shorten the median hospital stay.•Future research should focus on developing and analyzing the outcome of prehabilitation programs on a larger scale and for other major surgical indications.•More insight is needed regarding which patients most benefit from prehabilitation and how the programs can be more patient tailored.
The properties of time-dependent cylindrical and spherical, modified ion-acoustic (mIA) solitary structures in relativistic degenerate multi-ion plasmas (containing degenerate electron fluids, ...inertial positively-, as well as negatively-, charged light ions, and positively-charged static heavy ions) have been investigated theoretically. This investigation is valid for both non-relativistic and ultra-relativistic limits. The well-known reductive perturbation method has been used to derive the Korteweg-de Vries (K-dV) and the mK-dV equations for studying the basic features of solitary waves. The fundamental characteristics of mIA solitary waves are found to be significantly modified by the effects of the degenerate pressures of the electron and the ion fluids, their number densities, and the various charge states of heavy ions. The relevance of our results in astrophysical compact objects like white dwarfs and neutron stars, which are of scientific interest, is briefly discussed.
Cardiovascular disease (CVD) is highly prevalent in Suriname, a middle-income country with predominantly people of African and Asian ancestry. We examined whether the more comprehensive body ...composition measures determined by bioelectrical impedance analysis (BIA) are superior to the more traditional BMI and waist measures in relation to cardiovascular risk.
Data from the cross-sectional Healthy Life in Suriname (HELISUR) study were used to calculate BMI, waist-hip ratio, waist-to-height ratio, and waist circumference. BIA was used to estimate fat percentage, fat-free mass index, and fat-to-fat-free mass ratio. High cardiovascular risk was defined as 1) a 10-year Framingham coronary heart disease risk score ≥10% in African-Surinamese and ≥12% in Asian-Surinamese, and 2) an increased arterial stiffness (pulse wave velocity >10 m/s). Using logistic regression analysis, we pre-selected the strongest correlate (i.e. lowest p-value below 0.05) of all body composition items for both outcomes of cardiovascular risk separately, and subsequently, used forward logistic regression modelling to determine whether other measures added value to the initial model with the strongest correlate (−2 log-likelihood (–2LL) of initial model minus −2LL of new model, χ-square statistic >3.841, 1 df). Analyses were adjusted for sex, age and ethnicity.
We examined 691 participants (65% women; 48% African-Surinamese) with a mean age of 42 (SD 14) years. Waist circumference was the strongest correlate for high 10-year CVD risk in the total group, in men and African-Surinamese. In Asian-Surinamese, fat-free mass index was the strongest correlate of high 10-year CVD risk. Increased arterial stiffness was most strongly related with waist-to-height ratio in the total group and in African-Surinamese, and with BMI in men. None of the measures were significantly associated in women (for both outcomes) and Asian-Surinamese (for increased arterial stiffness). Forward selection showed that only BMI added value next to waist-to-height ratio in the total group in relation to increased arterial stiffness.
Waist measures, in particular waist circumference and waist-to-height ratio, and BMI should be used in African and Asian-Surinamese to identify who is at increased cardiovascular risk. Overall, we found little advantage in using BIA measures rather than simple anthropometric measures.
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