INTRODUCTION: Contrast-induced nephropathy (CIN) is a serious but preventable complication of coronary procedures. Trimetazidine (TMZ) has recently been explored for use in preventing post-procedural CIN due to its cellular anti-ischemic and antioxidant properties. The objective is to assess the efficacy of oral TMZ in the prevention of contrast induced nephropathy during elective coronary angiography and PCI among patients with renal impairment.

METHODS: We conducted a systematic search of the Cochrane Central Register of Controlled Trials, Pubmed/ MEDLINE, EMBASE, clinicaltrials.gov for articles published until June 2016 for randomized controlled trials examining the effects of adding oral TMZ to standard therapy in preventing CIN. Outcome measures were incidence of CIN, defined as a 0.5 mg/dl or ?25% increase in serum creatinine 48-72 hours after contrast exposure, and incidence of dialysisrequiring CIN. Validity of studies was assessed through a risk assessment tool available from Cochrane. Treatment effect was estimated by calculating the Mantel-Haenszelweighted risk ratio (RR) using a fixed-effects model available from RevMan 5.3.

RESULTS: A total of four studies comprising 714 patients (TMZ group=352, Control group=362) were included in the final analysis. Pooled results revealed the TMZ group was associated with significantly fewer incidences of CIN compared to control (RR 0.33, 95% confidence interval [CI], 0.20, 0.53; P<.00001), with a relative risk reduction of 67% and an absolute risk reduction of 11.04% (NNT=nine). No dialysis-requiring CIN was observed in the included studies.

CONCLUSION: The addition of oral TMZ to standard hydration confers a significant benefit in preventing CIN after coronary procedures among patients with mild to moderate renal impairment. We recommend the addition of TMZ to standard prevention strategies. However, a large well-designed trial should be conducted to determine its effect on other outcomes such as prevention of dialysis-requiring CIN and mortality. 

Human ; Trimetazidine ; Coronary Angiography ; Medline ; Creatinine ; Pubmed ; Risk Assessment ; Renal Insufficiency ; Kidney Function Tests

INTRODUCTION: Anthracycline is a cornerstone in the treatment of various cancers. One major limitation to its use is cardiotoxicity. Renin angiotensin system (RAS) inhibitors have been shown to attenuate myocardial injury, initial data is promising in its use as prophylaxis for anthracyclineinduced cardiotoxicity. The aim of the study is to determine effectiveness of prophylactic RAS inhibitors in preventing anthracycline-induced cardiotoxicity and adverse cardiac events among adult cancer patients

METHODS: Systematic search of databases PUBMED, MEDLINE, EMBASE, and CENTRAL was done. Selection criteria were: 1) randomized controlled trials (RCT) 2) adult cancer patients with normal ejection fraction and without heart failure symptoms 3) RAS inhibitors as prophylaxis versus placebo 4) development of cardiac events, all-cause mortality and left ventricular ejection fraction (LVEF) reduction as outcomes. Two reviewers independently assessed the trials. Disagreements were resolved with a third reviewer. Test for effect of intervention, heterogeneity, trial quality and risk of bias were assessed using the Cochrane Review Manager Software version 5.3.

RESULTS: Five RCTs involving 530 adult patients, with average age of 50± two years old, and average follow-up from six months to three years were included. Combined clinical outcomes of heart failure, cardiac events and all-cause mortality showed an RR of 0.27[95%CI 0.18, 0.40],p<0.00001, in favor of RAS inhibitors. There is same benefit in LVEF preservation with mean difference of 4.37%[95%CI 1.20, 7.55;p=0.007]. Exploratory subgroup analysis showed significant benefit in LVEF preservation with combined RAS inhibitor and beta-blocker, with mean difference of 2.45%[95%CI 1.27, 3.63]. There is overall significant heterogeneity (I2=95%). Excluding one article with high-risk population, after sensitivity analysis, showed same benefit but reduced heterogeneity.

CONCLUSION: Renin angiotensin system (RAS) inhibitors may be used as prophylaxis for cardiotoxicity. As prophylaxis, it reduced the clinical outcome of cardiac events, heart failure, and all-cause mortality among cancer patients needing anthracycline. Combined RAS inhibitor and betablocker limits LVEF reduction.

Human ; Male ; Female ; Cardiotoxicity ; Renin-angiotensin System ; Medline ; Stroke Volume ; Patient Selection ; Follow-up Studies ; Anthracyclines ; Pubmed ; Heart Failure ; Adrenergic Beta-antagonists ; Neoplasms

INTRODUCTION: The coronary collateral circulation (CCC) is an alternative source of blood supply in coronary artery disease (CAD). The prognostic value of the presence of CCC at the time of acute coronary syndrome (ACS) is undefined with regards to hard outcomes, particularly reduction in mortality. The study's aim is to determine if the presence of CCC demonstrated by coronary angiography during an ACS is associated with a reduction in mortality. 

METHODS: We conducted a systematic search of studies using MEDLINE, EMBASE, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases in all languages and examined reference lists of studies. The inclusion criteria were 1) observational; 2) population included adults >19 years old with an acute coronary syndrome; 3) reported data on mortality in association with the presence or absence of CCC on angiography; and 4) should have controlled for confounders by using logistic regression analysis. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale for observational studies. The outcome of interest was reduction in all-cause mortality, assessed using Mantel-Haenzel analysis of random effects to compute for risk ratios.

RESULTS: Pooled analysis from 11 identified trials with 8,370 subjects showed that among patients with ACS who underwent coronary angiography, the presence of CCC showed a trend towards benefit in terms of mortality, but was not statistically different from those without CCC [RR 0.65, (95% CI 0.38 to 1.12), p<0.0001, I2=74%]. In those ACS patients with CCC treated with PCI, a significant reduction in mortality was found [RR 0.43, (95% CI 0.29 to 0.64), p< 0.0001, I2=0%].

CONCLUSION: The presence of CCC during ACS showed a trend towards mortality reduction. Further, among patients treated with PCI, those with CCC had an incrementally significant reduction in mortality compared to those without CCC.

Coronary Artery Disease ; Collateral Circulation ; Coronary Angiography ; Acute Coronary Syndrome ; Odds Ratio ; Prognosis ; Language ; Medline ; Logistic Models ; Coronary Circulation ; Qualitative Research ; Cardiovascular System

BACKGROUND AND OBJECTIVE: Febrile neutropenia (FN) frequently develops among cancer patients receiving chemotherapy and is associated with significant morbidity and mortality. Although the use of empiric antibiotics has been a standard of care for FN according to the last 2010 Infectious Disease Society of America (IDSA) guidelines, the role of prophylactic antibiotics in patients with high risk features in preventing febrile neutropenia remains to be elucidated. This study aims to investigate the role of antibiotic prophylaxis in preventing post-chemotherapy FN among patients with hematologic and solid organ malignancies.

METHODS: A literature search of published English language clinical trials was performed using PubMed, MEDLINE, and the Cochrane Collaboration from January 1980 - October 2015. Four hundred thirty two articles were extracted from our literature search and narrowed down through specified inclusion and exclusion criteria. Results were analyzed based on 1) incidence of FN in post chemotherapy cancer patients, 2) mortality rate, and 3) incidence of FN with different antibiotics. Assessment of methodological quality of each study was done using the Jadad scale. Odds ratios and Forest plots were computed and generated respectively using RevMan 5.2 (© 2013 the Cochrane Collaboration).

RESULTS: Antibiotic prophylaxis reduced the incidence of FN (OR 0.59[0.37, 0.91]). Overall effect was significant; Z= 2.35 (p= 0.02). Febrile episodes occurred less frequently in those patients who received prophylactic antibiotic treatment (OR 0.43 [0.34, 0.53]) Z = 7.59 (p< 0.00001). The combined results in this sub-analysis on different antibiotic regimens used demonstrated that prophylaxis in general prevented FN by up to 3.51-fold among cancer patients who received chemotherapy, OR 3.51[3.10, 3.98]. Results were statistically significant at Z = 19.68, p < 0.00001.

CONCLUSION: Antibiotic prophylaxis reduces the incidence of FN among cancer patients treated with cytotoxic chemotherapy, decreases febrile episodes in neutropenic patients, and overall, prevented FN by up to 3.51-fold.

Human ; Male ; Female ; Middle Aged ; Antibiotic Prophylaxis ; Anti-bacterial Agents ; Medline ; Fever ; Pubmed ; Morbidity ; Neoplasms ; Febrile Neutropenia ; Forests

The concept of wellness has no single, universal acceptable definition. The situation gives room to developing and refining wellness both as a concept and an experience. This paper aimed to substantiate the concepts surrounding wellness within an illness experience. Beth Rodger's evolutionary method of concept analysis provided the organizing framework for this paper. The data source was a search of literature published from 2010-2016 on CINAHL, Medline, EBSCO, and Google scholar database. Trailing process is organized with particular focus on antecedents, attributes, and consequences.

The analysis found four attributes of wellness within illness namely: normalizing, independence, empowerment, and finding meaning strengthened by antecedents such as strong social support, motivation, constructive coping strategies, and cognitive reframing. Subsequently these may lead to adaptation to illness, being well, and living to illness. Looking at wellness and illness in dichotomy may lead to rote deftness thus expansion of the panorama of wellness within an illness experience may lead to more depth on the scientific understanding and varied application. Increased conceptual understanding and knowledge development on wellness will enable nurses in facilitating patient's adaptation during illness.

Motivation ; Medline ; Power (psychology) ; Knowledge ; Adaptation, Psychological ; Social Support ; Cognition

No abstract available.
Abstracting and Indexing as Topic ; *MEDLINE ; Periodicals as Topic/*statistics & numerical data ; Republic of Korea ; *Urology

There have been numerous studies done to explore the diagnostic performance of quantitative diffusion-weighted (DW) MR imaging to differentiate between benign and malignant pancreatic masses. However, the results have been inconsistent. We performed a meta-analysis to investigate whether DW-MR imaging can differentiate between these two diseases. Databases including MEDLINE, EMBASE and Cochrane Library were utilized to find relevant articles published between January 2001 and January 2014. A Stata version 12.0 and a Meta-Disc version 1.4 were used to describe primary results. Twelve studies with 594 patients, which fulfilled the inclusion criteria, were enrolled for the analysis. The pooled sensitivity and specificity of DW imaging was 0.91 (95% CI: 0.84, 0.95) and 0.86 (95% CI: 0.76, 0.93) respectively. The area under the curve of the summary receiver operating characteristic was 0.95 (95% CI: 0.93, 0.96). The results indicated that DW imaging might be a valuable tool for differentiating benign and malignant pancreatic masses.
Diffusion Magnetic Resonance Imaging ; methods ; Humans ; MEDLINE ; Pancreatic Neoplasms ; diagnostic imaging ; Radiography ; Sensitivity and Specificity

The concept of mentoring is important in nursing. Mentoring allows opportunities for a mentor to transfer knowledge and expertise in both theory and practice and a mentee to improve performance. This concept analysis aims to clarify the meaning of 'mentoring'. Attributes, antecedents, consequences, and a model case are presented to clarify this concept further. Review of literatures was conducted by using databases which include EBSCO, MEDLINE, and Google scholar. Findings showed that mentoring allows personal and professional growth of mentees. Closing the gap between theory and practice is achieved through an expert supervision of a mentor to a mentee. Mentoring plays a central role in the development of novice nurses as they integrate theoretical concepts into their practice. The benefits of mentoring are illuminated in the increasing competency of nurses in performing their roles to be globally competitive.

 

Mentors ; Mentoring ; Medline ; Knowledge ; Social Behavior

No abstract available.
*Databases, Bibliographic ; Humans ; Internet ; MEDLINE ; PubMed

With retrieval of MEDLINE database (from Jan 2006 to Dec 2010) and supplementary search on other important literatures, 29 overseas articles that were in accord with inclusive criteria were included. The results showed that the overseas scholars issued the international standard on human acupoint locations and proposed the localization system of animal acupoint model; discovered the new acupoint structure, characteristic of acupoint microcirculation, the states of the diseases could be specifically reflected through acupoint temperature, electric resistance, pressure and pain threshold, and the specific brainstem reaction could be induced by electroacupuncture at acupoints; verified initially the effect on nausea and vomiting with the related acupuncture methods at acupoints and explained the mechanisms on the local analgesia of acupuncture at acupoints; suggested that a further study should be expected on the low electric resistance property of acupoints and the effect specificity in the treatment of disease. Additionally, they were proposed that the domestic study should focus on the symptom treatment, correct application of logic reasoning, the secondary literature study and international exchange and cooperation. It is indicated that the overseas study has made the great progression on the acupoint locations, morphological structure, biological and physical properties, pathological reaction, stimulation effect, therapeutic effect and mechanism, and it provides the references for the domestic study in terms of study clues and methods.
Acupuncture ; trends ; Acupuncture Points ; Acupuncture Therapy ; trends ; Humans ; MEDLINE ; Publications