Empirical assessment of biases in cerebrospinal fluid biomarkers of Alzheimer's disease: an umbrella review and re-analysis of data from meta-analyses.

OBJECTIVE: Alzheimer's disease (AD) is a leading cause of years lived with disability in older age, and several cerebrospinal fluid (CSF) markers have been proposed in individual meta-analyses to be associated with AD but field-wide evaluation and scrutiny of the literature is not available. MATERIALS AND METHODS: We performed an umbrella review for the reported associations between CSF biomarkers and AD. Data from available meta-analyses were reanalyzed using both random and fixed effects models. We also estimated between-study heterogeneity, small-study effects, excess significance, and prediction interval. RESULTS: A total of 38 meta-analyses on CSF markers from 11 eligible articles were identified and reanalyzed. In 14 (36%) of the meta-analyses, the summary estimate and the results of the largest study showed non-concordant results in terms of statistical significance. Large heterogeneity (I2≥75%) was observed in 73% and small-study effects under Egger's test were shown in 28% of CSF biomarkers. CONCLUSIONS: Our results suggest that there is an excess of statistically significant results and significant biases in the literature of CSF biomarkers for AD. Therefore, the results of CSF biomarkers should be interpreted with caution.

Needs assessment for master of nursing programmes among Bangladesh nurses.

AIM: This study aimed to assess the intent to enrol in a master of nursing programme among Bangladesh nurses, identify preferred programme options and measure the association among intent to enrol in the programme, clinical competency and job satisfaction. BACKGROUND: Personal and professional aspects of potential students pursuing graduate education are beneficial in devising educational strategies. However, considering the pressing needs for higher nursing education, there are no masters of nursing programmes in Bangladesh. METHODS: This study used a descriptive correlational design. Nurses working in Bangladesh public sector were recruited to participate in a self-administered survey (n = 260). The questionnaire consisted of perception of job satisfaction, clinical competency and the need for educational options, including the intent to enrol in a master of nursing programme, preferred specialty area, curriculum content and career goals after graduation. Data were analysed using descriptive statistics and point-biserial correlation. RESULTS: Ninety per cent of the respondents reported that they intended to enrol in a master of nursing programme. Intention was significantly correlated with clinical competency but not with job satisfaction. The most preferred specialty areas were nursing management and education. Half of the respondents responded that teaching at nursing schools was a career goal after graduation. DISCUSSION: The results of the needs assessment for the programme reflected the unique interest and priorities of the current status of Bangladesh. CONCLUSIONS: The results indicate a strong motivation to enrol in a master of nursing programme, confidence in clinical competence and high demand for programme in nursing management and education. These findings should be considered to design the programme in order to meet the interest of Bangladesh nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Educational needs assessments should take precedence to ensure the best possible educational outcome and to produce competent nurses who will contribute in achieving the Millennium Development Goals of Bangladesh.

Proliferation and functional assessment of pseudo-islets with the use of pancreatic endocrine cells.

Many obstacles beset islet transplantation, particularly insufficient tissue mass. Previously, we reported production of pseudo-islets. In addition, there have been reports in which coculture with pancreatic islet and bone marrow mesenchymal stem cells (BMSCs) demonstrated positive effects on pancreatic islet function. The purpose of this study was to perform morphologic and functional evaluations of pancreatic pseudo-islets cocultured with BMSCs. Pancreatic endocrine cells (PECs) were collected with a previously reported method; bone marrow was aspirated from the rat femur. Subsequently, PECs and BMSCs cocultured at high density on low-cell-binding culture dishes kept suspended by shaking. The functionality and characteristics of the mixed cell complexes were evaluated by glucose challenge, insulin enzyme-linked immunosorbent assay, reverse-transcription polymerase chain reaction, and immunohistochemistry. Through expansion for 2 weeks in continuous culture passages, ∼1 million PECs were recovered after aggregation. They presented spherical shapes and sizes similar to naïve islets, according to phase-contrast microscopy. The spheroid aggregates of pancreatic islet cells and BMSCs showed fortified functions and maintained viability. In conclusion, PECs served as a cell source for pseudo-islets, which were both morphologically and genetically similar to naïve islets. We also suggest a manufacturing method for mixed cellular complexes from 2 different origins that can improve secretion ability and cell differentiation.

Needs regarding care and factors associated with unmet needs in disease-free survivors of surgically treated lung cancer.

BACKGROUND: To evaluate the long-term needs of lung cancer survivors and to explore factors associated with unmet need. PATIENTS AND METHODS: We recruited lung patients treated with curative surgery from 2001 through 2006 at two centers in Korea. Needs in the domains of information, supportive care, education and counseling, and socioeconomic support were measured. We selected the four most frequently reported items of unmet need among 19 items in four domains. RESULTS: The most frequently reported unmet needs were Complementary and alternative medicine (CAM) and folk remedies (59.8%) in the Information domain, Counseling and treatment of depression and anxiety (63.5%) in the Supportive care domain, diet, exercise and weight control (55.1%) in the Education and counseling domain and Financial support (90.4%) in the socioeconomic support domain. Unmet needs for psychological treatment was significantly greater in participants who were employed (adjusted odds ratio [aOR], 2.25; 95% confidential interval [CI], 1.12 to 4.53). Unmet needs for diet, exercise and weight control were significantly greater in participants who had not received chemotherapy (aOR, 1.76; 95% CI, 1.09 to 2.85). Unmet need for financial support was greater in participants who were married (aOR, 4.14, 95%CI, 1.12 to 15.22) and those who had not received chemotherapy (aOR, 5.91, 95%CI, 1.91 to 18.31). CONCLUSION: There were substantial unmet needs for information regarding psychological support, education for diet and exercise, and financial support among lung cancer survivors.

Clinical assessment of renal function stabilization after living donor nephrectomy.

BACKGROUND: Few studies have evaluated the long-term effects of kidney donation on the donors themselves. This study investigated postoperative renal function stabilization in kidney donors after living-donor transplantation to determine the optimal follow-up period. METHODS: Between March 2006 and July 2010, 203 patients in our hospital underwent live donor nephrectomy. Renal function recovery patterns were analyzed by calculating the postoperative rate of change of their Modification of Diet in Renal Disease study equation estimating glomerular filtration rate (MDRD-GFR) versus their preoperative level (%MDRD). We divided normal (n = 121) versus chronic kidney disease subjects (CKD; MDRD-GFR < 60 mL/min/1.73 m(2) at 6 months postoperatively, n = 82) for 1 year follow-up to compare time to renal function stabilization using the repeated measured data method. RESULTS: When all donors were considered together at 1 month after transplantation, MDRD-GFRs were significantly increased compared with earlier follow-up times (for postoperative days 1, 4, and 7), P values were < .001, .006, and .002, respectively). Among all donors, there was no significant difference between MDRD-GFRs at 1 versus 3, 6, and 12 months posttransplantation (P < .05 in all three comparisons), indicating renal function stabilization. Importantly the %MDRD was significantly higher among the normal than the CKD group at postoperative months 1, 3, and 6 (P < .05 for all comparisons), although after 12 months there was no significant difference between the groups (69.06 ± 9.28% versus 70.14 ± 8.38%, P = .442). CONCLUSION: After live donor kidney transplantation, renal function began to stabilize at 1 month postoperatively. Poor renal functional recovery and CKD later were predicted by inferior stabilization at 1 month postnephrectomy. These data suggested that even patients with normal GFRs should be followed beyond 1 year postoperatively to determine their ultimate renal functional outcomes.

Generic Bell inequalities for multipartite arbitrary dimensional systems.

We present generic Bell inequalities for multipartite arbitrary dimensional systems. The inequalities that any local realistic theory must obey are violated by quantum mechanics for even dimensional systems. A large set of variants are shown to naturally emerge from the generic Bell inequalities. We discuss particular variants of Bell inequalities that are violated for all the systems including odd dimensional systems.

Patient compliance and persistence with antihyperglycemic drug regimens: evaluation of a medicaid patient population with type 2 diabetes mellitus.

BACKGROUND: Drug use patterns among patients with type 2 diabetes mellitus have been studied in the general population but not specifically in the Medicaid population. OBJECTIVE: The purpose of this study was to examine antihyperglycemic drug use patterns among Medicaid recipients with type 2 diabetes and assess patients' persistence and compliance with different antihyperglycemic drug regimens. METHODS: Pharmaceutical claims data from Medi-Cal for January 1996 through September 1998 were analyzed to investigate antihyperglycemic drug use patterns over a 1-year and 2-year period. Prescription refill data were examined to assess patient compliance and persistence. RESULTS: Of the 37,431 patients in the 1-year follow-up cohort, 79.6% started antihyperglycemic treatment with monotherapy (ie, drug therapy with a single class of antihyperglycemic medication), 14.5% with insulin alone, 3.9% with polytherapy (ie, drug therapy with > or = 2 classes of medication other than insulin), and 2.1% with insulin plus another therapy. Of the patients receiving monotherapy, 85.3% were taking a sulfonylurea, 14.0% were taking metformin, and 0.7% were taking another agent. In the 1-year follow-up, 55.5% of patients taking metformin alone, 67.2% of those taking sulfonylurea alone, and 83.9% of those taking metformin plus sulfonylurea (M + S) did not undergo any modification of their regimen (except discontinuation of therapy). Among these patients, those taking metformin or sulfonylurea alone had approximately 65% more days of continuous (or persistent) treatment (129 and 128 days, respectively) per patient per year than did patients taking polytherapy (78 days). In addition, sulfonylurea or metformin monotherapy was associated with a 36% higher compliance rate than M + S polytherapy (177 days vs 130 days). CONCLUSION: Simple 1-drug antihyperglycemic regimens were associated with better compliance and persistence (as measured by prescription refill data) than more complex multiple-drug regimens among patients with type 2 diabetes in the Medi-Cal population.

[Patients' preferences for nurses' nonverbal expressions of warmth during nursing rounds and administration of oral medication].

Nursing involves deep human interpersonal relationships between nurses and patients. But in modern Korea, the nurse-patient relationship tends to be ritualistic and mechanestic. Patients usually express the hope that nurses be more tender and kind. Patients expect nurses to express their warmth especially through nonverbal behaviour. This study was conducted to identify patients' preferences for nurse's nonverbal expressions of warmth. Through the confirmation of these preferences, nurses may learn how to enhance their interpersonal relationships with patients. Subjects for the study were 73 patients who had been admitted to a university teaching hospital for at least three days and agreed to be interviewed by the investigator. The interactions were studied nonverbal expressions of warmth during nursing rounds and administration of oral medication. The interview schedule was especially designed by the investigator to measure the nurse's posture, the distance between the nurse and the patient, the nurse's eye contact, facial expression, hand motion and head nodding. Data analysis included frequencies, percentages and X2-test. The results of this study may be summerized as follows: 1. Patient's preferences for nurse's nonverbal expressions of warmth during nursing rounds. Preferred nurse's posture was sitting (50.7%) or standing (49.3%) opposite the patient. Preferred distance between the nurse and the patient was close to the bed (93.2%), less than 1m. Preferred eye contact was directed to the patient's eyes or their affected part (41.1%). Preferred facial expression was a smile (97.3%). Preferred hand motions were light gestures (41.1%). Patients preferred head nodding which approved their own opinions (69.9%). 2. Patient's preferences for nurse's nonverbal expressions of warmth during administration of oral medication. Preferred nurse's posture was standing and waiting to confirm that the medication had been taken (58.9%). Preferred distance from the patient was at arm's length, 0.5-1m (64.4%). Patients preferred direct eye contact (58.9%) and a smile (94.5%). Patients preferred that the nurse put the medicine directly the patient's hand (64.4%). Whether the nurse nodded her head or not was not considered important. 3. The relation of general characteristics and patient's preferences for nurse's nonverbal expressions of warmth during nursing rounds and administration of oral medication. During nursing rounds, the age of subjects (p = 0.010) and the standard of education (p = 0.026) related to the distance between the nurse and the patient. The sick hospital ward related to the eye contact (p = 0.017) and facial expression (p = 0.010).(ABSTRACT TRUNCATED AT 400 WORDS)