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1.
J Sports Sci Med ; 23(1): 107-113, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38455444

ABSTRACT

Research on the external physical load on elite youth soccer players during the weekly training microcycle in competitive periods and official matches is limited. The aims of this study were twofold: a) investigate possible differences in external physical load (PL) across player positions in U17 elite youth soccer players during official matches; b) determine the weekly training to match physical load ratio (WTMLr) across player positions. The sample included 20 outfield players from an elite soccer academy (mean age 15.94 ± 0.25 years) playing in four positions: central defender (CD), full-back (FB), central midfielder (CM) and Striker (S). Data were collected during the spring in-season period for 17 official matches played in a 4-3-3 game format. Indicators of external physical load monitored were: total distance (TD); total distance in high-speed running (HSR; > 16.1 km.h-1); total distance in sprint running (SPR; > 21.6 km.h-1); and relative physical load intensity (%HSR). The WTMLr was calculated for TD, HSR, SPR and %HSR as the ratio of the average weekly sum of training PL to the average sum of PL in an official match for a given players' position. Collectively, the training intensity during a one-week microcycle (%HSR in WTMLr) achieved only 76 % of match demands. CD performed significantly lower in all measured indicators of external PL during the official match than all other positions (p < 0.05; g > 0.80) except for TD in S. S achieved significantly higher SPR during official matches compared to CD (p < 0.05; g > 0.80), CM, and FB (g > 0.80). In contrast, CD reported higher WTMLr (medium-large effect size) in HSR and SPR indicators than all other positions. CM performed significantly higher %HSR in WTMLr than S and FB (p < 0.05; g > 0.80). Results revealed insufficient training intensity relative to match demands and, at the same time, weekly training PL did not meet match demands (especially in HSR and SPR) for players across the different positions. Therefore, practitioners should select appropriate training methods (drills and games) to ensure sufficient training intensity (HSR and SR metrics) and consider using the WTMLr, which can be used to help optimise and individualise training PL for different player positions.


Subject(s)
Running , Soccer , Humans , Adolescent , Geographic Information Systems , Seasons
2.
Soins Pediatr Pueric ; 45(336): 19-21, 2024.
Article in French | MEDLINE | ID: mdl-38365390

ABSTRACT

Who says Neonatal Individualized Developmental Care and Assessment Program (Nidcap) says observation of the baby's behavior. But what is a Nidcap observation? Who are the professionals who can use this method and what are their objectives? How does an observation of this type take place? How do professionals approach their analyzes with parents? Which babies benefit from it? What does this practice bring to the caregiver who uses it? So many questions that are important to address to better understand the Nidcap observation.


Subject(s)
Infant, Premature , Intensive Care Units, Neonatal , Infant, Newborn , Humans , Behavior Observation Techniques , Child Development , Parents
3.
Health Care Anal ; 32(2): 141-164, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38285121

ABSTRACT

The term 'environment' is not uniformly defined in the public health sciences, which causes crucial inconsistencies in research, health policy, and practice. As we shall indicate, this is somewhat entangled with diverging pathogenic and salutogenic perspectives (research and policy priorities) concerning environmental health. We emphasise two distinct concepts of environment in use by the World Health Organisation. One significant way these concepts differ concerns whether the social environment is included. Divergence on this matter has profound consequences for the understanding of health and disease, for measures derived from that understanding targeting health promotion and disease prevention, and consequently, for epistemic structures and concept development in scientific practice. We hope to improve the given situation in public health by uncovering these differences and by developing a fruitful way of thinking about environment. Firstly, we side with the salutogenic conception of environment as a health resource (as well as a source of health risks). Secondly, we subdivide the concept of environment into four health-oriented environmental categories (viz., natural, built-material, socio-cultural, and psychosocial) and we link these with other theoretical notions proposed in the health sciences literature. Thirdly, we propose that in public health 'environment' should be understood as consisting of all extrinsic factors that influence or are influenced by the health, well-being, and development of an individual. Consequently, none of the four categories should be excluded from the concept of environment. We point out the practical relevance and fruitfulness of the conception of environment as a health source and frame this in causal terms, representing individual health environments as causal networks. Throughout, we side with the view that for the design of human health-promoting settings, increased attention and consideration of environmental resources of salutogenic potential is particularly pressing.


Subject(s)
Public Health , Humans , Social Environment , Environment , Environmental Health , Health Policy , Health Promotion
4.
Therapie ; 79(1): 13-22, 2024.
Article in English | MEDLINE | ID: mdl-38065821

ABSTRACT

Therapeutic strategies are shifting from a "one-size-fits-all" population-based approach to a stratified approach targeting groups with similar characteristics, or even individuals, tailoring treatments to the unique characteristics of each patient. Since such strategies rely on increasingly complex knowledge and healthcare technologies, along with an understanding of the tools of precision medicine, the appropriate dissemination and use of these strategies involves a number of challenges for the medical community. Having evaluation methodologies that have been jointly designed with the institutional, industrial, academic stakeholders, and also patients, like streamlining the processes and externally validating performances, could enhance the relevance of the "evaluation" aspect of precision medicine. Creating a network of expert precision-medicine centers and ensuring that precision-medicine procedures are reimbursed by social security would guarantee fair and sustainable access. Finally, training healthcare professionals, creating interfaces between precision-medicine expert centers and primary care professionals as well as patients, and integrating individual patient data into medical records are all key drivers that will enable information from precision-medicine to be made available and guarantee the proper use of these approaches.


Subject(s)
Delivery of Health Care , Precision Medicine , Humans , Patients
5.
Qual Health Res ; 34(3): 239-251, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37933668

ABSTRACT

The National Health Service (NHS) cardiac rehabilitation patient care pathway has remained largely unchanged for many years despite, on average, half of all eligible patients declining to engage. To investigate reasons for non-engagement, we explored the experiences of ten cardiac patients who participated in cardiac rehabilitation, dropped out, or declined, as well as experiences of seven people deemed significant others by participants. Our ethnographic study involved participant observations, repeat in-depth semi-structured interviews, and reflexive journaling. Reflexive thematic analysis was conducted, focusing on participants' lived experiences. Utilising Bourdieusian concepts of habitus, capital, and field, this article highlights how personal biography, material conditions, and dispositional inclinations combine to make cardiac health care decision-making individual and complex. Despite this, health professionals were not always attuned to specific circumstances arising from differences in patients' experiences and lifeworlds. By considering service improvement recommendations that acknowledge socio-cultural influences, cardiac rehabilitation can work towards providing patients and their significant others with more appropriate, personalised, and person-centred support.


Subject(s)
Cardiac Rehabilitation , Humans , State Medicine , England , Anthropology, Cultural , Health Personnel
7.
Rev. esp. anestesiol. reanim ; 70(9): 509-535, Noviembre 2023. tab, graf
Article in Spanish | IBECS | ID: ibc-227061

ABSTRACT

Este grupo es producto del acuerdo de colaboración firmado por la Sociedad de Medicina Intensiva de Madrid (SOMIAMA) y la Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid (SAR MADRID), por el que las organizaciones acordaron crear grupos de trabajo conjuntos para mejorar la atención al paciente crítico.El dolor, el malestar, la agitación y el delirio causan sufrimiento, retrasan el alta y pueden provocar complicaciones graves en los pacientes ingresados en las unidades de cuidados críticos médicos y quirúrgicos y en las unidades de cuidados postanestésicos. Los principales objetivos en este tipo de unidades incluyen: asegurar el confort de los pacientes que sufren o se recuperan de una enfermedad crítica. Evitar las complicaciones asociadas a las medidas, sobre todo farmacológicas, adoptadas para asegurar ese confort. (AU)


This group is a product of the collaboration agreement signed by Sociedad de Medicina Intensiva de Madrid (SOMIAMA) and Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid (SAR MADRID), under which the organisations agreed to create joint working groups to improve critical patient care.Pain, discomfort, agitation, and delirium cause suffering, delay discharge, and can lead to serious complications in patients admitted to medical and surgical critical care units and post-anaesthesia care units. The main objectives in this type of unit include: Ensuring the comfort of patients suffering or recovering from a critical illness. Avoiding complications associated with the measures, particularly pharmacological, taken to ensure that comfort. (AU)


Subject(s)
Humans , Pain Management/methods , Analgesia/methods , Conscious Sedation/methods , Intensive Care Units , Emergence Delirium/therapy
8.
Cureus ; 15(9): e45038, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37829964

ABSTRACT

In the field of anaesthesia, artificial intelligence (AI) has become a game-changing technology. Applications of AI include keeping records, monitoring patients, calculating and administering drugs, and carrying out mechanical procedures. This article explores the current uses, challenges, and prospective applications of AI in anaesthesia practices. This review discusses AI-supported systems like anaesthesia information management systems (AIMS), mechanical robots for carrying out procedures, and pharmacological models for drug delivery. AIMS has helped in automated record-keeping, predicting bad events, and monitoring the vital signs of the patient. Their application has a vital role in improving the efficacy of anaesthesia management and patient safety. The application of AI in anaesthesia comes with its own unique difficulties. Noteworthy obstacles include issues with data quantity and quality, technical limitations, and moral and legal dilemmas. The key to overcoming these barriers is to set guidelines for the ethical use of AI in healthcare, improve the reliability and comprehension of AI systems, and certify the health data precision and security. AI has very bright potential. Exciting future directions include developments in AI and machine learning thus development of new applications, and the possible enhancement in training and education. Potential research areas include the application of AI to chronic disease management, pain management, and the reinforcement of anaesthesiologists' education. AI could be used to design authentic lifelike training simulations and individualized student feedback systems, hence transforming anaesthesia education and training methodology. For this review, we conducted a PubMed, Google Scholar, and Cochrane Database search in 2022-2023 and retrieved articles on AI and its uses in anaesthesia. Recommendations for future research and development include strengthening the safety and reliability of health data, building a better understanding of AI systems, and looking into new areas of use. The power of AI can be used to innovate anaesthesia practices by concentrating on these areas.

9.
Rev Esp Anestesiol Reanim (Engl Ed) ; 70(9): 509-535, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37742996

ABSTRACT

This group is a product of the collaboration agreement signed by SOMIAMA (Sociedad de Medicina Intensiva de Madrid) and SAR MADRID (Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid) under which the organisations agreed to create joint working groups to improve critical patient care. Pain, discomfort, agitation, and delirium cause suffering, delay discharge, and can lead to serious complications in patients admitted to medical and surgical critical care units and post-anaesthesia care units. The main objectives in this type of unit include: Ensuring the comfort of patients suffering or recovering from a critical illness.Avoiding complications associated with the measures, particularly pharmacological, taken to ensure that comfort.


Subject(s)
Analgesia , Anesthesia , Delirium , Humans , Delirium/prevention & control , Intensive Care Units , Pain
10.
J Anal Psychol ; 68(4): 729-752, 2023 09.
Article in English | MEDLINE | ID: mdl-37551164

ABSTRACT

This written exchange is between a senior and a younger Jungian analyst on issues relevant to the development of analytical psychology throughout the world today. The younger analyst, Stefano Carpani, considers himself a neo-Jungian. He explains to John Beebe, known for post-Jungian contributions to the study of typology, integrity, and gender, how important it is to include sociological perspectives alongside those that stem from the Jungian practice of relational psychoanalysis. The degree to which analysis has become an extended meditation on the relation of individual self-exploration to supra-personal Self-realization is emphasized by both authors, who envision this introspection leading to an expanded inner openness that Carpani has called "absolute freedom." The authors conclude that absolute freedom is a space of engaged reflection that can permit an informed but individualized approach to the complexities of the world soul today.


Il s'agit d'un échange par écrit entre deux analystes jungiens - l'un plus agé, l'autre plus jeune - sur des questions concernant le développement actuel de la psychologie analytique à travers le monde. L'analyste plus jeune, Stefano Carpani, se considère comme un néo-jungien. Il explique à John Beebe - qui est connu pour ses contributions post- jungiennes à l'étude de la typologie, de l'intégrité et du genre - à quel point il est important d'inclure des perspectives sociologiques aux côtés de celles qui découlent de la pratique jungienne de la psychanalyse relationnelle. Les deux auteurs insistent sur le degré auquel l'analyse est devenue une méditation prolongée concernant la relation entre l'exploration individuelle de soi et une réalisation supra-personnelle du Soi. Ils envisagent que cette introspection mène à une ouverture intérieure élargie que Carpani a appelée « liberté absolue ¼. Les auteurs concluent que la liberté absolue est un espace de réflexion engagée qui peut permettre une approche éclairée mais individualisée des complexités de l'âme du monde aujourd'hui.


Este intercambio escrito es entre un analista junguiano senior y otro más joven sobre temas relevantes para el desarrollo de la psicología analítica en el mundo actual. El analista más joven, Stefano Carpani, se considera neo-jungiano. Explica a John Beebe, conocido por sus contribuciones postjungianas al estudio de la tipología, la integridad y el género, lo importante que es incluir perspectivas sociológicas junto a las que se derivan de la práctica junguiana del psicoanálisis relacional. Ambos autores enfatizan el grado en que el análisis devino en una prolongada meditación en la relación entre la exploración individual del self y la realización suprapersonal del Self, y visualizan como esta introspección conduce a una expansiva apertura interior que Carpani ha llamado "libertad absoluta". Los autores concluyen que la libertad absoluta es un espacio de reflexión comprometida que puede permitir una aproximación fundamentada y singular a las complejidades del alma del mundo actual.


Subject(s)
Meditation , Psychoanalysis , Male , Humans , Psychotherapy , Communication , Motivation
11.
Eur Arch Paediatr Dent ; 24(3): 387-399, 2023 Jun.
Article in English | MEDLINE | ID: mdl-37081211

ABSTRACT

PURPOSE: To develop and evaluate an individualised habituation programme for children with autism spectrum disorder (ASD) to enhance their cooperation during a routine dental examination. METHODS: In collaboration with school personnel, we developed and evaluated a research-based habituation programme comprising a toolbox with aids (pictures, videos, appliances, social stories) for preparations and gradual exposure to a 10-step dental examination. The habituation programme was subjected to a small-scale evaluation involving 17 children with ASD living in Rogaland, Norway. Changes in cooperation were registered using Frankl behaviour rating scale. Further, school personnel were interviewed using semi-structured interviews, and the data obtained were analysed through content analysis. RESULTS: Fourteen children (82%) completed the dental examination. Compared to previous accomplishments reported by the caregivers, an increased number of children completed the examination with a mirror and probe and were able to take an X-ray with good compliance following the habituation programme. The registration of cooperation (Frankl score) during each session indicated varying progression rates. Further, changing the dentist did not influence compliance, and most children showed a similar level of cooperation towards the dental examination one year later. Further, school personnel highlighted the need for preparations that could facilitate control and the importance of catering to individual needs. CONCLUSION: An individualised approach combining preparations and behavioural methods in close collaboration with school personnel can increase cooperation during a dental examination in children with ASD.


Subject(s)
Autism Spectrum Disorder , Humans , Child , Habituation, Psychophysiologic , Parents , Caregivers , Norway
12.
Wien Klin Wochenschr ; 135(Suppl 1): 147-156, 2023 Jan.
Article in German | MEDLINE | ID: mdl-37101036

ABSTRACT

Hypertension is one of the most important comorbidities of diabetes, contributing significantly to death and leading to macrovascular and microvascular complications. When assessing the medical priorities for patients with diabetes, treating hypertension should be a primary consideration. In the present review practical approaches to hypertension in diabetes, including individualized targets for preventing specific complications are discussed according to current evidence and guidelines. Blood pressure values of about 130/80 mm Hg are associated with the best outcome; most importantly, at least blood pressure values < 140/90 mm Hg should be achieved in most patients. Angiotensin converting enzyme inhibitors or angiotensin receptor blockers should be preferred in patients with diabetes, especially in those who also have albuminuria or coronary artery disease. Most patients with diabetes require combination therapy to achieve blood pressure goals; agents with proven cardiovascular benefit should be used (including, besides angiotensin converting enzyme inhibitors and alternatively angiotensin receptor blockers, dihydropyridin-calcium antagonists and thiazide diuretics), preferable in single-pill combinations. Once the target is achieved, antihypertensive drugs should be continued. Newer antidiabetic medications such as SGLT-2-inhibitors or GLP1-receptor agonists have also antihypertensive effects.


Subject(s)
Diabetes Mellitus , Hypertension , Humans , Antihypertensive Agents/therapeutic use , Austria , Hypertension/drug therapy , Hypertension/complications , Diabetes Mellitus/drug therapy , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Blood Pressure , Angiotensin Receptor Antagonists/therapeutic use
13.
J Obstet Gynaecol ; 43(1): 2171280, 2023 Dec.
Article in English | MEDLINE | ID: mdl-36708518

ABSTRACT

This study explored the effect of individualised nutritional intervention on the postpartum nutritional status of patients with the growth and development of their offspring. This study included pregnant women with gestational diabetes mellitus (GDM) at Hangzhou Women's Hospital in 2019. At 42 days after childbirth, the HbA1c (95% CI: 0.44-0.56%, p < 0.001), the FPG (95% CI: 0.01-0.26 mmol/L, p < 0.05), 2HPG (95% CI: -0.01-0.73 mmol/L, p < 0.05) and TCH (95% CI: -0.34-0.00 mmol/L, p < 0.05) level of the control group were 0.14, 0.36, and 0.17 mmol/L higher than in the intervention group. There were no differences in TG and HGB between the two groups (all p > 0.05). There were significant differences in the number of macrosomia and neonatal weight between the two groups (both p < 0.05). Differences in WHZ after childbirth were not statistically significant between the two groups (all p > 0.05). Individualised nutritional intervention could improve blood glucose levels 42 days after childbirth and reduce macrosomia incidence in pregnant women with GDM.Impact statementWhat is already known on this subject? Individualised nutrition intervention can improve blood glucose status and complications during pregnancy, thus improving pregnancy outcomes.What the results of this study add? Individual nutrition intervention improved the blood glucose and nutritional status of patients at 42 days postpartum, but there was no difference in the growth and development indicators of their offspring at 0-24 months.What the implications are of these findings for clinical practice and/or further research? Improve nutritional intervention programs for gestational diabetes, improve blood glucose during pregnancy and postpartum, to improve pregnancy outcomes and reduce the occurrence of type 2 diabetes and other metabolic diseases; Extend the monitoring range of the growth and development of the offspring of gestational diabetes, find the problems and timely carry out the nutritional intervention, to improve the development of the offspring.


Subject(s)
Diabetes Mellitus, Type 2 , Diabetes, Gestational , Infant, Newborn , Humans , Female , Pregnancy , Fetal Macrosomia , Blood Glucose/metabolism , Nutritional Status , Weight Gain , Postpartum Period
14.
J Sports Sci ; 41(20): 1868-1874, 2023 Oct.
Article in English | MEDLINE | ID: mdl-38240501

ABSTRACT

Speed is an essential skill in sports performance and an important performance metric in talent identification. This study aims to evaluate and compare the sprint acceleration characteristics across different age groups in an elite soccer academy. A total of 141 elite academy soccer players were recruited to participate in the study, and they were assigned to their respective competitive age groups, ranging from under-14 to the B-team. An individual in-situ acceleration-speed (A-S) profile was assessed and derived from Global Position System (GPS) speed-acceleration raw data, from 10 consecutive football sessions, in the beginning of the season. The results showed that under-14 players exhibited significantly lower theoretical maximum speed (S0) (ηp2 = 0.215, p < 0.01) when compared with all other age groups. However, no differences were found between maximum theoretical acceleration (A0) and A-S slope between age groups. The results suggest that sprint mechanical profiles of young soccer athletes remain stable throughout their athletic development. Nevertheless, younger athletes have less capacity to apply horizontal force at higher speeds (S0).


Subject(s)
Athletic Performance , Running , Soccer , Humans , Cross-Sectional Studies , Acceleration
15.
Stud Health Technol Inform ; 299: 75-88, 2022 Nov 03.
Article in English | MEDLINE | ID: mdl-36325848

ABSTRACT

The explosion of interest in exploiting machine learning techniques in healthcare has brought the issue of inferring causation from observational data to centre stage. In our work in supporting the health decisions of the individual person/patient-as-person at the point of care, we cannot avoid making decisions about which options are to be included or excluded in a decision support tool. Should the researcher's routine injunction to use their findings 'with caution', because of methodological limitations, lead to inclusion or exclusion? The task is one of deciding, first on causal plausibility, and then on causality. Like all decisions these are both sensitive to error preferences (trade-offs). We engage selectively with the Artificial Intelligence (AI) literature on the causality challenge and on the closely associated issue of the 'explainability' now demanded of 'black box' AI. Our commitment to embracing 'lifestyle' as well as 'medical' options for the individual person, leads us to highlight the key issue as that of who is to make the preference- sensitive decisions on causal plausibility and causality.


Subject(s)
Artificial Intelligence , Delivery of Health Care , Humans , Machine Learning , Causality , Decision Making
16.
Eur J Popul ; 38(4): 811-834, 2022 Oct.
Article in English | MEDLINE | ID: mdl-36237295

ABSTRACT

This study examines the money-subjective well-being nexus by studying the link between changes in jointly and solely (i.e. respondents' own and their partner's own) held gross wealth and changes in married individuals' subjective well-being. Joint assets reflect norms of sharing responsibilities and resources. Solely held assets, in contrast, offer individual economic independence. Using wealth data from the German Socio-Economic Panel Study (SOEP; 2002, 2007, 2012, 2017), we estimate individual fixed effects regressions. Although coefficients for all three wealth measures are positive, our results highlight that only increases in jointly held wealth are associated with statistically significant increases in spouses' life satisfaction in Germany. Despite expectations about a stronger relevance of joint wealth for men compared to women in line with men's role as a financial provider for the family, we do not find substantial gender differences in the positive association between increases in joint wealth and life satisfaction. In light of the individualisation of marriages, our results highlight that the personal benefits associated with marital sharing of wealth seem to trump those of economic independence and financial autonomy. Supplementary Information: The online version contains supplementary material available at 10.1007/s10680-022-09630-7.

17.
Stud Health Technol Inform ; 298: 112-116, 2022 Aug 31.
Article in English | MEDLINE | ID: mdl-36073467

ABSTRACT

One possible cause of overprescribing (or insufficient deprescribing) is the failure to explicitly address the individual's life expectancy (LE). For example, if a LE estimate shows the person has six months to live, this should influence the prescribing of a medication that offers benefits only over a much longer LE. Predicting exactly the number of years a person will live is impossible, but probabilistic forecasting is possible and arguably essential, both for the selection of the optimal intervention and for meeting the 'reasonable patient' standard of information about the harms and benefits of alternative options. One side-effect of the COVID-19 pandemic has been to bring mortality into greater prominence, hopefully facilitating its discussion in the clinic as part of the 'new normal'. This paper outlines the case for introducing LE into prescribing decisions as a way of making more individualised decisions and potentially reducing overprescribing. It concentrates on how the clinical task of arriving at individualised estimates of LE might be tackled, especially in the case of the growing number of older patients with heterogeneous sociodemographic characteristics who are experiencing multiple long term conditions of varying severity and are frequently subject to 'polypharmacy'.


Subject(s)
COVID-19 Drug Treatment , Pandemics , Decision Making , Humans , Life Expectancy , Polypharmacy
18.
Br J Anaesth ; 129(5): 815-825, 2022 11.
Article in English | MEDLINE | ID: mdl-36031417

ABSTRACT

BACKGROUND: Individualised positive end-expiratory pressure (PEEP) may optimise pulmonary compliance, thereby potentially mitigating lung injury. This meta-analysis aimed to determine the impact of individualised PEEP vs fixed PEEP during abdominal surgery on postoperative pulmonary outcomes. METHODS: Medical databases (PubMed, Embase, Web of Science, ScienceDirect, Google Scholar, and the China National Knowledge Infrastructure) were searched for RCTs comparing fixed vs individualised PEEP. The composite primary outcome of pulmonary complications comprised hypoxaemia, atelectasis, pneumonia, and acute respiratory distress syndrome. Secondary outcomes included oxygenation (PaO2/FiO2) and systemic inflammatory markers (interleukin-6 [IL-6] and club cell protein-16 [CC16]). We calculated risk ratios (RRs) and mean differences (MDs) with 95% confidence interval (CI) using DerSimonian and Laird random effects models. Cochrane risk-of-bias tool was applied. RESULTS: Ten RCTs (n=1117 patients) met the criteria for inclusion, with six reporting the primary endpoint. Individualised PEEP reduced the incidence of overall pulmonary complications (141/412 [34.2%]) compared with 183/415 (44.1%) receiving fixed PEEP (RR 0.69 [95% CI: 0.51-0.93]; P=0.016; I2=43%). Risk-of-bias analysis did not alter these findings. Individualised PEEP reduced postoperative hypoxaemia (74/392 [18.9%]) compared with 110/395 (27.8%) participants receiving fixed PEEP (RR 0.68 [0.52-0.88]; P=0.003; I2=0%) but not postoperative atelectasis (RR 0.93 [0.81-1.07]; P=0.297; I2=0%). Individualised PEEP resulted in higher PaO2/FiO2 (MD 20.8 mm Hg [4.6-36.9]; P=0.012; I2=80%) and reduced systemic inflammation (lower plasma IL-6 [MD -6.8 pg ml-1; -11.9 to -1.7]; P=0.009; I2=6%; and CC16 levels [MD -6.2 ng ml-1; -8.8 to -3.5]; P<0.001; I2=0%) at the end of surgery. CONCLUSIONS: Individualised PEEP may reduce pulmonary complications, improve oxygenation, and reduce systemic inflammation after abdominal surgery. CLINICAL TRIAL REGISTRATION: CRD42021277973.


Subject(s)
Interleukin-6 , Pulmonary Atelectasis , Humans , Positive-Pressure Respiration/methods , Pulmonary Atelectasis/etiology , Pulmonary Atelectasis/prevention & control , Hypoxia/prevention & control , Hypoxia/complications , Inflammation
19.
Clin Med (Lond) ; 22(3): 257-265, 2022 05.
Article in English | MEDLINE | ID: mdl-35443970

ABSTRACT

BACKGROUND: Evidence and guidelines increasingly support an individualised approach to care for people with type 2 diabetes and individualisation of glycaemic targets in response to patient factors. METHODS: We undertook a scoping review of the literature for evidence of factors impacting upon glycated haemoglobin target individualisation in adults with type 2 diabetes. Data were analysed thematically with the themes inductively derived from article review. FINDINGS: Evidence suggests that presence of cardiovascular disease, hypoglycaemia unawareness, severe hypoglycaemia, limited life expectancy, advanced age, long diabetes duration, frailty, cognitive impairment, disability, extensive comorbidity, diabetes distress and patient preference should inform the setting of glycaemic targets. CONCLUSION: The management of people with diabetes is complex. In clinical practice, many patients will have a variety of factors that should be considered when personalising their care. Approaches to personalised care and glycaemic treatment targets should be undertaken as part of a shared decision-making process between physician and patient. Use of electronic records might enable greater efficiency and more widespread use of personalised care plans for people with diabetes.


Subject(s)
Diabetes Mellitus, Type 2 , Hypoglycemia , Adult , Blood Glucose , Diabetes Mellitus, Type 2/drug therapy , Glycated Hemoglobin , Humans , Hypoglycemic Agents/therapeutic use
20.
Forensic Sci Int Synerg ; 4: 100222, 2022.
Article in English | MEDLINE | ID: mdl-35257092

ABSTRACT

Many forensic scientists consider that identification (individualisation) - in the sense of statements of the kind "the questioned item and the known item come from the same source" - is a concept that is central to their discipline. This is so despite decade-long, fundamental critiques levelled by both practitioners and academics against the conceptual and practical feasibility of forensic identification. Oddly, there is a constant stream of publications in (peer-reviewed) forensic science journals that treat forensic identification axiomatically as a valid object of study, sidestepping the fundamental critiques. This paper reviews and discusses three exemplary strands of publications that exemplify this persistent trend. These strands are called descriptivism, diagnosticism and machinism. The latter term refers to methods borrowed from the now increasingly popular approaches used in the field of machine learning. In turn, descriptivism and diagnosticism refer to general design aspects of mainstream research methods, illustrated here through a critical review of two recent papers on, respectively, forensic odontology and a framework for interpreting fingerprint evidence. The critique of the use of 'identification' in these strands of publication includes, but goes beyond, semantic details and the reiteration of long-known shortcomings of obsolete technical language such as 'match' and 'matching'. Specifically, this paper exposes deeper problems such as the subtle and argumentatively unfounded carrying-over of source conclusions to ultimate issues and the use probability concepts for questions that require more than the mere quantification of uncertainty. This paper submits that in order to foster trust in an era of continually expanding publishing activities, it should be a vital interest to forensic science journals to better examine what identification-related research can and cannot legitimately purport to achieve.

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