Rationale
We believe that this study represents an innovative approach to clarifying the definitions of routine, empathic and compassionate health care, as well as of sympathy. We emphasize the ...importance of affective empathy and its intensification in the context of patient suffering (compassion), without abandoning the ideal of clinical equanimity.
Methods
We develop a pedagogical model for clinicians and trainees who are weaker in their empathic skills that includes four levels of growth. We clarify representative obstacles to empathic and compassionate care in education and clinical practice. We summarize the four beneficiaries of empathic and compassionate care (clinicians, patients, trainees, institutions). We suggest areas for future research, including the development of a compassion scale and conclude with a statement on how the conceptual and professional confusion we address adversely impacts patients and trainees. The article represents the consensus work of a group of health care professionals and students at Stony Brook University Hospital and School of Medicine who have been engaged in this project for several years through the Center for Medical Humanities, Compassionate Care, and Bioethics, established in August of 2008.
Conclusions
We discern a shift away from concepts of clinical empathy and compassionate care that deny a significant place for an affective component and that idealize ‘detachment’.
The SPARC (Stroke Prevention: Assessment of Risk in a Community) study was designed to identify risk factors for stroke and cardiovascular disease using transesophageal echocardiography and carotid ...ultrasonography. This protocol was undertaken to establish a cohort in which putative risk factors for stroke were identified so that subsequent follow-up could discern the roles these risk factors play in stroke incidence.
This was a prospective, population-based study. A randomly selected cohort comprised 1475 Olmsted County, Minnesota, residents aged 45 years or older, of whom 588 agreed to participate. Transesophageal echocardiography and carotid ultrasonography were used for evaluation of the subjects. Prevalences of various cardiovascular and cerebrovascular conditions were determined.
Transesophageal echocardiography was successfully completed in 581 subjects. The prevalence
(±SE) of patent foramen ovale was 25.6% (±1.9%), and that of atrial septal aneurysm was 2.2% (±0.6%). The prevalence of aortic atherosclerosis increased with age and was most common in the descending aorta, particularly in subjects 75 to 84 years old. The prevalence of strands on native valve was 46.4% (±2.2%). Carotid ultrasonography data for 567 participants revealed minimal atherosclerotic disease. Most subjects had minimal or mild carotid occlusive disease. The prevalence of moderate (50%-79%) and severe (80%-99%) stenosis was 7.7% (±1.1%) and 0.3% (±0.2%), respectively.
This prospective study defines the prevalence of multiple potential cardiovascular and cerebrovascular risk factors, providing population-based data for ongoing follow-up of the risk of stroke.
Surgical site infections (SSIs) remain a significant cause of morbidity and mortality in patients undergoing traumatic exploratory laparotomy. The goal of this study was to compare antibiotic usage ...and subsequent outcomes in patients undergoing traumatic exploratory laparotomy. A retrospective chart analysis and a chi-square test of independence were performed to examine the relation between preoperative cefoxitin versus ceftriaxone and metronidazole and the rate of SSI development. 323 patients were analyzed, 111 patients receiving cefoxitin and 212 patients receiving ceftriaxone and metronidazole. The proportion of patients who developed SSI was 16.2% for the cefoxitin group and 9.9% for the ceftriaxone and metronidazole group, X2 (1, N = 323) = 2.7, P = .098, thus displaying no statistical difference in the development of SSIs between patients in the cefoxitin group when compared to the ceftriaxone and metronidazole group.
This study investigated differences in drug use and sexual behaviors among from 237 male and 123 female heroin users in Dar es Salaam, Tanzania. Multivariate models of risk of needle sharing were ...estimated using multivariate logistic regression. Men were significantly older, more likely to inject only white heroin, share needles, and give or lend used needles to other injectors. Women were more likely to be living on the streets, have injected brown heroin, have had sex, have had a higher number of sex partners, and have used a condom with the most recent sex partner. Being male and earning less than US $46 in the past month were significant predictors of increased risk of needle sharing. Despite differences in sociodemographic, drug use, and sexual behaviors by gender, both male and female injectors in Dar es Salaam exhibit elevated risk of HIV infection associated with drug use.
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and ...pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.
Chaque année Hypertension Canada publie une mise à jour de ses lignes directrices fondées sur des données probantes relatives au diagnostic, à l'évaluation, à la prévention et au traitement de l'hypertension chez l'adulte et l'enfant. Cette année, les lignes directrices applicables aux adultes et aux enfants sont combinées en un seul document. Les nouvelles lignes directrices 2018 portant précisément sur l'hypertension pendant la grossesse sont publiées séparément. Pour 2018, cinq nouvelles lignes directrices sont présentées, et une ligne directrice existante portant sur les seuils et les cibles de pression artérielle dans le contexte de la thrombolyse dans un cas d'accident vasculaire cérébral ischémique aigu est révisée. L'utilisation de tensiomètres-bracelets validés pour l'estimation de la pression artérielle chez les personnes dont le bras a une circonférence élevée est à présent incluse. Des indications sont données pour les mesures de la pression artérielle dans le cadre d'un suivi à l'aide de méthodes normalisées et de dispositifs électroniques (oscillométriques) positionnés au niveau du bras chez les personnes hypertendues, ainsi que de la surveillance de la pression artérielle ambulatoire ou à domicile chez les personnes sujettes au « syndrome de la blouse blanche ». Nous recommandons notamment de procéder à une évaluation du risque cardiovasculaire global de toutes les personnes atteintes d'hypertension afin de les inciter à adopter de saines habitudes de vie permettant d’abaisser leur pression artérielle. Enfin, chez les personnes atteintes d'insuffisance cardiaque (présentant une fraction d'éjection < 40 %) qui sont symptomatiques malgré un traitement de cette affection à des doses appropriées et conforme aux lignes directrices, il est recommandé d'utiliser une association de médicaments inhibiteurs des récepteurs de l'angiotensine et de la néprilysine au lieu d’un inhibiteur de l’enzyme de conversion de l'angiotensine ou d'un antagoniste des récepteurs de l'angiotensine en monothérapie. Les données probantes et la justification qui sous-tendent chacune de ces lignes directrices sont analysées.
We present time-of-arrival (TOA) measurements and timing models of 47 millisecond pulsars observed from 2004 to 2017 at the Arecibo Observatory and the Green Bank Telescope by the North American ...Nanohertz Observatory for Gravitational Waves (NANOGrav). The observing cadence was three to four weeks for most pulsars over most of this time span, with weekly observations of six sources. These data were collected for use in low-frequency gravitational wave searches and for other astrophysical purposes. We detail our observational methods and present a set of TOA measurements, based on "narrowband" analysis, in which many TOAs are calculated within narrow radio-frequency bands for data collected simultaneously across a wide bandwidth. A separate set of "wideband" TOAs will be presented in a companion paper. We detail a number of methodological changes, compared to our previous work, which yield a cleaner and more uniformly processed data set. Our timing models include several new astrometric and binary pulsar measurements, including previously unpublished values for the parallaxes of PSRs J1832−0836 and J2322+2057, the secular derivatives of the projected semimajor orbital axes of PSRs J0613−0200 and J2229+2643, and the first detection of the Shapiro delay in PSR J2145−0750. We report detectable levels of red noise in the time series for 14 pulsars. As a check on timing model reliability, we investigate the stability of astrometric parameters across data sets of different lengths. We also report flux density measurements for all pulsars observed. Searches for stochastic and continuous gravitational waves using these data will be subjects of forthcoming publications.
We present a new analysis of the profile data from the 47 millisecond pulsars comprising the 12.5 yr data set of the North American Nanohertz Observatory for Gravitational Waves, which is presented ...in a parallel paper (Alam et al., hereafter NG12.5). Our reprocessing is performed using "wideband" timing methods, which use frequency-dependent template profiles, simultaneous time-of-arrival (TOA) and dispersion measure (DM) measurements from broadband observations, and novel analysis techniques. In particular, the wideband DM measurements are used to constrain the DM portion of the timing model. We compare the ensemble timing results to those in NG12.5 by examining the timing residuals, timing models, and noise-model components. There is a remarkable level of agreement across all metrics considered. Our best-timed pulsars produce encouragingly similar results to those from NG12.5. In certain cases, such as high-DM pulsars with profile broadening or sources that are weak and scintillating, wideband timing techniques prove to be beneficial, leading to more precise timing model parameters by 10%-15%. The high-precision, multiband measurements of several pulsars indicate frequency-dependent DMs. Compared to the narrowband analysis in NG12.5, the TOA volume is reduced by a factor of 33, which may ultimately facilitate computational speed-ups for complex pulsar timing array analyses. This first wideband pulsar timing data set is a stepping stone, and its consistent results with NG12.5 assure us that such data sets are appropriate for gravitational wave analyses.
The vast majority of rugby union (‘rugby’) participants are community-based players; however, the majority of injury surveillance studies reported relate to the elite, professional game. A potential ...reason for this dearth of studies could be the perceived difficulty of using the consensus statement for injury recording at the community level. The aim of this study was to identify areas where the consensus statement could be adapted for easier and more appropriate implementation within the community setting.
Round-table discussion.
All community-based injury surveillance issues were discussed during a 2-day facilitated round-table meeting, by an 11-person working group consisting of researchers currently active in rugby-related injury surveillance, sports medicine and sports science issues. The outcomes from the meeting were summarised in a draft guidance document that was then subjected to an extensive iterative review prior to producing methodological recommendations.
Each aspect of the rugby-specific consensus statement was reviewed to determine whether it was feasible to implement the standards required in the context of non-elite rugby and the resources available within in a community setting. Final recommendations are presented within a community-based injury report form.
It is recommended that whenever possible the rugby-specific consensus statement for injury surveillance studies be used: this paper presents an adapted report form that can be used to record injury surveillance information in community rugby if suitable medical support is not available.
Background: Screening biomarkers for ovarian cancer are needed because of its late stage at diagnosis and poor survival. We used microarray technology to identify overexpressed genes for secretory ...proteins as potential serum biomarkers and selected prostasin, a serine protease normally secreted by the prostate gland, for further study. Methods: RNA was isolated and pooled from three ovarian cancer cell lines and from three normal human ovarian surface epithelial (HOSE) cell lines. Complementary DNA generated from these pools was hybridized to a microarray slide, and genes overexpressed in the cancer cells were identified. Real-time quantitative polymerase chain reaction was used to examine prostasin gene expression in ovarian cancer and HOSE cell lines. Anti-prostasin antibodies were used to examine prostasin expression and to measure serum prostasin by an enzyme-linked immunosorbent assay in 64 case patients with ovarian cancer and in 137 control subjects. Previously determined levels of CA 125, an ovarian cancer marker, were available from about 70% of all subjects. All statistical tests were two-sided. Results: Prostasin was detected by immunostaining more strongly in cancerous ovarian epithelial cells and stroma than in normal ovarian tissue. The mean level of serum prostasin was 13.7 μg/mL (95% confidence interval CI = 10.5 to 16.9 μg/mL) in 64 case patients with ovarian cancer and 7.5 μg/mL (95% CI = 6.6 to 8.3 μg/mL) in 137 control subjects (P<.001, after adjustment for the subject's age, year of collection, and specimen quality). In 14 of 16 case patients with both preoperative and postoperative serum samples, postoperative prostasin levels were statistically significantly lower than preoperative levels (P = .004). In 37 case patients with nonmucinous ovarian cancer and in 100 control subjects for whom levels of CA 125 and prostasin were available, the combination of markers gave a sensitivity of 92% (95% CI = 78.1% to 98.3%) and a specificity of 94% (95% CI = 87.4% to 97.7%) for detecting ovarian cancer. Conclusions: Prostasin is overexpressed in epithelial ovarian cancer and should be investigated further as a screening or tumor marker, alone and in combination with CA 125.
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