Systemic inflammation in heart failure with preserved ejection fraction

Despite major advances in the treatment of CHF, a prognosis remains unacceptably purehigh. The reasons of it may be systemic inflammation and the problem of poor adherence to medications. Objective: We estimated systemic inflammation manifestations in patients with HF with preserved ejection fraction (HFPEF) and the impact of a patient education program and care plan in general practice on systemic inflammation. Methods: The study was a randomized clinical trial over 6 months. In the control group, the patients (n=41) were managed according to National guidelines. In addition to that usual care, patients in the intervention group (n=44) received education and nurse consultations. We estimated systemic inflammation by blood C-reactive protein level (CRP, high sensitivity method). We measured body mass index (BMI), б-minute walk test (6MWT) distance, emotional status with the Hospital Anxiety and Depression Scale and quality of life with the Minnesota Living with Heart Failure Questionnaire. Results: a mean age of patients was 67 (59-71) years, males - 31%. A mean CRP level was 2 (0,92 - 4) mg/L. The patients with CRP level >1 mg/L had more pronounced anxiety level. The patients with CRP level >3 mg/L had higher BMI. The dynamic of CRP level correlated positively with dynamic of anxiety level and negatively with dynamic of 6MWT distance. The patients with positive dynamic of CRP level had the improvement of total quality of life score and a physical dimension score. In the control group CRP level increased if compare with the starting of study. Conclusion: The patients with HFPEF had high activity of systemic inflammation, associated with anxiety, obesity, worth functional status and quality of life. The nurse-led patient education program and care plan led to stabilization of systemic inflammation with HFPEF.Несмотря на прогресс в терапии ХСН, прогноз заболевания остается плохим, что может быть связано с активностью системного воспаления и низкой приверженностью пациентов к лечению. Цель исследования: изучить активность системного воспаления у пациентов с сердечной недостаточностью с сохраненной систолической функцией (СН-ССФ) и оценить его динамику при наблюдении в общей практике. Материалы и методы: В группе контроля (n=41) проводилось стандартное лечение пациентов, в группе вмешательства (n=44), дополнительно групповое обучение и непрерывное наблюдение с участием медсестры в течение 6 месяцев. Оценивались тест шестиминутной ходьбы (ТШХ), индекс массы тела (ИМТ), психический статус (Госпитальная шкала тревоги и депрессии), качество жизни (Миннесотский опросник для больных с ХСН), высокочувствительный тест определения С - реактивного белка в крови (СРВ). Результаты: Средний возраст участников был 67 (59 - 71) лет. Доля мужчин - 31%. Средний уровень СРВ в выборке составил 2 (0,92 - 4) мг/л. Более выраженный уровень тревоги отмечен у пациентов с концентрацией СРВ >1 мг/л. В подгруппе пациентов с уровнем СРВ >3 мг/л отмечался более высокий ИМТ. Повышение уровня СРВ в период наблюдения сопровождалось увеличением уровня тревоги и уменьшением дистанции ТШХ. Снижение уровня СРВ сопровождалось улучшением общего качества жизни и физических возможностей справляться с повседневными нагрузками. К концу исследования в группе контроля уровень СРВ увеличился, а в группе вмешательства не изменился. Заключение: Пациенты с СН-ССФ характеризуются высокой активностью системного воспаления, которая связана с тревогой, ожирением, худшим функциональным статусом и качеством жизни. Обучение пациентов и наблюдение за ними с участием медсестры способствует стабилизации активности системного воспаления при СН-ССФ

Perancangan dan Analisis Kelayakan Pemasaran Kacamata Dribble yang Ergonomis

MBTC(Mahaka Basketball Training Camp) merupakan salah satu sekolah basket yang sangat ingin memajukan olahraga basket di tanah air, karena itu banyak program dan tindakan yang telah dilakukan oleh MBTC. Salah satunya adalah dengan meningkatkan kemampuan dribble dari siswanya. Usaha yang dilakukan selama ini belum maksimal karena belum ada alat bantu yang pas dan efektif Alat bantu berupa kacamata dribble yang pernah dipakai ukurannya tidak sesuai dengan siswa MBTC yang sebagian besar anak-anak usia 6-12 tahun dan tidak efektif dalarn meningkatkan· kemampuan dibble siswa. Muneulnya masalah ini membuat terdapatnya kesempatan untuk melakukan penelitian untuk memperbaiki alat yang telah ada bahkan merancang kacamata dribble dengan desain yang baru dan memiliki dimensi yang pas untuk anak-anak usia 6-12 tahun serta efektif dalam meningkatkan kemarnpuan dribble pemakai. Penelitian difokuskan pada peraneangan kaearnata yang berdasarkan dimensi tubuh pemakai dan keinginan dari ealon pembeli dan pengguna kacamata. Selain itu juga dilakukan analisis kelayakan dalarn pemasaran kaearnata berdasarkan data-data pasar, teknis dan keuangan. Penelitian ini dilakukan dengan cara penyebaran kuesioner kepada 20 orang pelatih dari MBTC dan Kobanita. Setelah melakukan pengumpulan data dan anal isis hasil pengolahan data, diketahui bahwa kacamata dnhble yang Ielah ada kebesaran dan menimbulkan rasa sakit pada bagian hidung dan mata, karena itu kacarnata baru dirancang dengan menggunakan data antropometri siswa dan memakai bahan dasar plastik yang lunak. Kacarnata baru memiliki Iebar 13 em, Iebar bagian hidung 2.25 em dan panjang bagian samping 7 em. Hasil dari perancangan adalah 95% siswa tidak merasakan sakit lagi dan kacamata efektif dalarn meningkatkan kemarnpuan siswa melakukan latihan Harrison Dribble Test. Terjadi kenaikan jumlah kerueut sebesar 31.28% dan hasil yang diperoleh sudah sesuai dengan standar yang diinginkan oleh pelatih. Kondisi kesehatan siswa saat melakukan tes adalah sehat doogan pengukuran denyut nadi dan suhu badan yang berada dalarn range yang ditentukan tim medis MBTC. Setelah itu dilakukan analisis kelayakan pemasaran kacarnata dribble tersebut, hasil yang didapatkan adalah kacarnata dribble tersebut layak untuk dipasarkan. Pertimbangannya karena Total Project Cost (TPC) yang dibutuhkan adalah sebesar Rp 33.514.900,00 dan menghasilkan Net Presem Value (NPV) sebesar Rpl06.526.266,00 dengan Minimum Attractive Rate of Return (MARR) sebesar 18%. Internal Rate of Return (IRR) dari investasi ini adalah sebesar 474.5% dengan discounted payback period selama 3.8 bulan. Dari hasil analisis sensitivitas diketahui bahwa investasi ini masih layak apabila teijadi penurunan nilai harga jual maksimal sebesar 45.7% pertahun dan penurunan sales maksimal sebesar 45.7% pertahun. Harga jual kacamata dribble adalah sebesar Rp. 67.600,00 per unit. Dengan berbagai strategi dan taktik pemasaran yang dibahas termasuk cara-eara promosi investasi kacamata dribble ini dapat memberikan keuntungan yang diharapkan

Efficacy of longidaza in prevention of sclerous processes after surgery on urinary tracts

The success of the surgery performed on the urinary tract, much depends on preventing scar-sclerotic complications in the postoperative period. In this regard, an important issue is to find a path genetically based methods to prevent the development of urinary tract strictures. After performing surgical procedures on the urinary tract of a complex drug therapy by Longidaza 3000 IU in combination with magnetic-laser therapy can reduce the development of sclerotic complications in 3 times, which reduces the number of repeat surgery, and can be recommended for use in clinical practice

Effects of physician-nurse substitution on clinical parameters: a systematic review and meta-analysis

BACKGROUND: Physicians' shortage in many countries and demands of high-quality and affordable care make physician-nurse substitution an appealing workforce strategy. The objective of this study is to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the impact of physician-nurse substitution in primary care on clinical parameters. METHODS: We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected peer-reviewed RCTs comparing physician-led care with nurse-led care on changes in clinical parameters. Study selection and data extraction were performed in duplicate by independent reviewers. We assessed the individual study risk of bias; calculated the study-specific and pooled relative risks (RR) or weighted mean differences (WMD); and performed fixed-effects meta-analyses. RESULTS: 11 RCTs (N = 30,247) were included; most were from Europe, generally small with higher risk of bias. In all studies, nurses provided care for complex conditions including HIV, hypertension, heart failure, cerebrovascular diseases, diabetes, asthma, Parkinson's disease and incontinence. Meta-analyses showed greater reductions in systolic blood pressure (SBP) in favour of nurse-led care (WMD -4.27 mmHg, 95% CI -6.31 to -2.23) but no statistically significant differences between groups in the reduction of diastolic blood pressure (DBP) (WMD -1.48 mmHg, 95%CI -3.05 to -0.09), total cholesterol (TC) (WMD -0.08 mmol/l, 95%CI -0.22 to 0.07) or glycosylated haemoglobin (WMD 0.12%HbAc1, 95%CI -0.13 to 0.37). Of other 32 clinical parameters identified, less than a fifth favoured nurse-led care while 25 showed no significant differences between groups. LIMITATIONS: disease-specific interventions from a small selection of healthcare systems, insufficient quantity and quality of studies, many different parameters. CONCLUSIONS: trained nurses appeared to be better than physicians at lowering SBP but similar at lowering DBP, TC or HbA1c. There is insufficient evidence that nurse-led care leads to better outcomes of other clinical parameters than physician-led care

Substitution of physicians by nurses in primary care: a systematic review and meta-analysis

Background In many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of physician-nurse substitution in primary care. Methods We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected and critically appraised published randomised controlled trials (RCTs) that compared nurse-led care with care by primary care physicians on patient satisfaction, Quality of Life (QoL), hospital admission, mortality and costs of healthcare. We assessed the individual study risk of bias, calculated the study-specific and pooled relative risks (RR) or standardised mean differences (SMD); and performed fixed-effects meta-analyses. Results 24 RCTs (38,974 participants) and 2 economic studies met the inclusion criteria. Pooled analyses showed higher overall scores of patient satisfaction with nurse-led care (SMD 0.18, 95% CI 0.13 to 0.23), in RCTs of single contact or urgent care, short (less than 6 months) follow-up episodes and in small trials (N 200) RCTs. Higher quality RCTs (with better allocation concealment and less attrition) showed higher rates of hospital admissions and mortality with nurse-led care albeit less or not significant. The results seemed more consistent across nurse practitioners than with registered or licensed nurses. The effects of nurse-led care on QoL and costs were difficult to interpret due to heterogeneous outcome reporting, valuation of resources and the small number of studies. Conclusions The available evidence continues to be limited by the quality of the research considered. Nurse-led care seems to have a positive effect on patient satisfaction, hospital admission and mortality. This important finding should be confirmed and the determinants of this effect should be assessed in further, larger and more methodically rigorous research

Prostate blood flow in patients with benign prostatic hyperplasia complicated by urine retention

Benign prostatic hyperplasia is the most frequent disease among middle and old aged men and connected with increasing of lifetime of men. The incidence of the disease is 42% to 87% in different aged groups. Purpose: to improve the diagnosis of benign prostatic hyperplasia without complications and with urine retention. 38 patients with benign prostatic hyperplasia underwent transrectal sonography with estimation of blood flow by Doppler. Blood flow speed measured in subcapsular and paraurethral arteries with estimation of diameter and blood speed in veins of the paraprostatic tissue. Transrectal sonography showed the changes in the prostatic blood-flow, especially in case of urine retention. Transrectal ultrsonography plays an important role in the evaluation of the prostatic blood-flow