Phenylpropanoid-enriched broccoli seedling extract can reduce inflammatory markers and pain behavior.

BACKGROUND: Pain is a worldwide problem requiring an effective, affordable, non-addictive therapy. Using the edible plant broccoli, a growth protocol was developed to induce a concentrated combinatorial of potential anti-inflammatories in seedlings. METHODS: A growth method was utilized to produce a phenylpropanoid-rich broccoli sprout extract, referred to as Original Extract (OE). OE was concentrated and then resuspended for study of the effects on inflammation events. A rabbit disc model of inflammation and degeneration, and, a mouse model of pain behavior were used for in vivo and in vitro tests. To address aspects of mammalian metabolic processing, the OE was treated with the S9 liver microsome fraction derived from mouse, for use in a mouse in vivo study. Analytical chemistry was performed to identify major chemical species. Continuous variables were analyzed with a number of methods including ANOVA, and two-tailed t tests, as appropriate. RESULTS: In a rabbit spine (disc) injury model, inflammatory markers were reduced, and levels of regenerative markers were increased as a result of OE treatment, both in vivo and in vitro. In a mouse pain behavioral model, after treatment with S9 liver microsome fraction, the resultant extract significantly reduced early and late pain behavior in response to a pain stimulus. The OE itself reduced pain behavior in the mouse pain model, but did not achieve the level of significance observed for S9-treated extract. Analytical chemistry undertaken on the extract constituents revealed identities of the chemical species in OE, and how S9 liver microsome fraction treatment altered species identities and proportions. CONCLUSIONS: In vitro and in vivo results indicate that the OE, and S9-treated OE broccoli extracts are worthwhile materials to develop a non-opiate inflammation and pain-reducing treatment.

Enriching nursing knowledge and practice in Jordanian government hospitals through basic life support simulation training: A randomized controlled trial.

Background: Healthcare providers must possess the necessary knowledge and skills to perform effective cardiopulmonary resuscitation (CPR). In the event of cardiopulmonary arrest, basic life support (BLS) is the initial step in the life-saving process before the advanced CPR team arrives. BLS simulation training using manikins has become an essential teaching methodology in nursing education, enhancing newly employed nurses' knowledge and skills and empowering them to provide adequate resuscitation. Objective: This study aimed to evaluate the potential effect of BLS simulation training on knowledge and practice scores among newly employed nurses in Jordanian government hospitals. Methods: A total of 102 newly employed nurses were randomly assigned to two groups: the control group (n = 51) received standard training, and the experimental group (n = 51) received one full day of BLS simulation training. The training program used the American Heart Association (AHA)-BLS-2020 guidelines and integrated theoretical models such as Miller's Pyramid and Kolb's Cycle. Both groups were homogeneous in inclusion characteristics and pretest results. Knowledge and practice scores were assessed using 23 multiple-choice questions (MCQs). Data were analyzed using one-way repeated measures ANOVA. Results: The results indicated significant differences in knowledge scores, F(2, 182) = 58.514, p <0.001, and practice scores, F(2, 182) = 20.134, p <0.001, between the control and experimental groups at all measurement times: pretest, posttest 1, and posttest 2. Moreover, Cohen's d reflected the effectiveness of BLS simulation training as an educational module, showing a large effect (Cohen's d = 1.568) on participants' knowledge levels and a medium effect (Cohen's d = 0.749) on participants' practice levels. Conclusion: The study concludes that BLS simulation training using the AHA-BLS-2020 guidelines and integrating theoretical models such as Miller's Pyramid and Kolb's Cycle significantly improves knowledge and practice scores among newly employed nurses, proving highly effective in enhancing their competencies in performing CPR. Implementing BLS simulation training in nursing education programs can significantly elevate the proficiency of newly employed nurses, ultimately improving patient outcomes during cardiopulmonary arrest situations. This training approach should be integrated into standard nursing curricula to ensure nurses are well-prepared for real-life emergencies. Trial Registry Number: NCT06001879.

Medical device related pressure ulcers in Jordan: Prevalence study among critically ill patients.

Background: Medical device-related pressure ulcers are increasingly common in critical care units. These ulcers can be complicated due to the necessity of the device for diagnosis or treatment. Purpose: To determine the prevalence of and risk for medical device-related pressure ulcers in critical care units in Jordan in addition to identifying the preventive measures for those ulcers as well as identifying the most frequently used medical devices that cause ulcers and to assess the relationships between prevention measures and developing ulcers. Methods: A cross-sectional survey was used to assess ulcers among 318 patients who were elder than 18 years old. Data collection was based on an outline published by the European Pressure Ulcer Advisory Panel, Braden Scale, and an author-developed specific checklist. Results: The prevalence rate of medical device-related pressure ulcers was 38.1%. Most affected sites were sacrum and heel, and most affected were those with old age, being admitted to public hospitals, and with a prolonged hospital stay. About half of the patients (46.3%) had severe risk. Only 17% of the patients who were at risk got adequate preventive measures. Face masks, endotracheal tubes, pulse oximetry probes, and intravenous catheters were associated with almost half of the ulcers. Conclusion: Medical device-related pressure ulcers are threats to patient safety and quality of nursing care in hospitals, which require determining appropriate preventive measures. Key messages:Medical device-related pressure ulcers are common among patients in critical care units, which raise the need to evaluate the prevalence of such type of ulcers in those patients.Three hundred and eighteen patients were investigated for the prevalence of medical device-related pressure ulcers through a cross-sectional survey.Patients in critical care units in Jordan had a high prevalence rate for medical device-related pressure ulcers, which require the need to apply appropriate preventive measures.

Self-Treatment with Antibiotics: Knowledge level, Prevalence and Indications for Practicing Among University Students in Jordan.

BACKGROUND: Self-treatment with antibiotics involves obtaining medicines without a prescription, sharing medicines with members of one's social circle, or using leftover medicines stored at home. OBJECTIVE: Assess the prevalence, knowledge level, reasons for practicing self-treatment of antibiotic among undergraduate university students. METHODS: The study was conducted cross-sectional on a sample of 201 students. A pre-validated questionnaire called "self-treatment with antibiotics", containing 27 close-ended questions, was administered to each subject. Data were analyzed using SPSS version 16 and the results were expressed as counts and percentages. RESULTS AND DISCUSSION: Knowledge about self-treatment with antibiotics was good in general, and health-related students had a better level of knowledge about self-treatment with antibiotics than non-health-related students. The majority of the participants had not used self-treatment with antibiotics. Gender, age, and the last time antibiotic taken affected self-treatment with antibiotics. The most common indication for self-treatment with antibiotics was flu, cold, and tonsillitis. The most common reason for practicing self-treatment with antibiotics was being considered as a convenient and rapid solution. Internet was the main source for university students regarding knowledge about antibiotic use and resistance. CONCLUSION: Self-treatment with antibiotics is affected by several social and demographic variables, and the role of media, public policies, university curricula as well as physicians and pharmacists should be enforced and activated to eliminate inappropriate uses of antibiotics and to correct misconceptions that encourage self-treatment with antibiotics.

Prostate Cancer-based Interventions' Efficacy on Knowledge and Adherence Intention to Healthy Lifestyle among Men.

BACKGROUND: Previous Literature has supported educational program efficacy, but no studies have been found to examine Prostate Cancer-based interventions' Efficacy on knowledge and adherence intention to a healthy lifestyle among Men in Jordan. PURPOSE: The purpose of the current study was to assess Prostate Cancer-based interventions' efficacy on knowledge and adherence intention to a healthy lifestyle among Men in Jordan. METHODS: A quasi-experimental research with one group pretest-posttest design was used and the study was conducted in Masjids (praying place), Amman, Jordan. The population consists of Jordanian Men aged 40 years and above. The sample size was 76 men, who fulfilled the inclusion criteria. The tool used for data collection was a structured questionnaire. RESULTS: Paired sample t-test showed that the change in the mean knowledge scores (9.5), p < .001 was statistically significant 1 month after the application of the program. In addition, the change in the mean adherence to healthy lifestyle scores (4.7), p < .05 was statistically significant 1 month after the application of the structured teaching program. CONCLUSION: Jordanian men had gained knowledge and Adherence Intention to Healthy Lifestyle regarding prostate cancer after the implementation of a structured teaching program. IMPLICATIONS FOR PRACTICE: Educational program aimed at motivating men to increase their knowledge of prostate cancer and having adherence intention to a healthy lifestyle.
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DyeVert™ PLUS EZ System for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Diagnostic Coronary Angiography and/or Percutaneous Coronary Intervention: A UK-Based Cost-Utility Analysis.

BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is a complication commonly associated with invasive angiographic procedures and is considered the leading cause of hospital-acquired acute kidney injury. CI-AKI can lead to a prolonged hospital stay, with a substantial economic impact, and increased mortality. The DyeVert™ PLUS EZ system (FDA approved and CE marked) is a device that has been developed to divert a portion of the theoretical injected contrast media volume (CMV), reducing the overall volume of contrast media injected and aortic reflux, and potentially improving long-term health outcomes. OBJECTIVES: To assess the long-term costs and health outcomes associated with the introduction of the DyeVert™ PLUS EZ system into the UK health care service for the prevention of CI-AKI in a cohort of patients with chronic kidney disease (CKD) stage 3-4 undergoing diagnostic coronary angiography (DAG) and/or percutaneous coronary intervention (PCI), and to compare these costs and outcomes with those of the current practice. METHODS: A de novo economic model was developed based on the current pathway of managing patients undergoing DAG and/or PCI and on evidence related to the clinical effectiveness of DyeVert™ in terms of its impact on relevant clinical outcomes and health service resource use. Clinical data used to populate the model were derived from the literature or were based on assumptions informed by expert clinical input. Costs included in the model were from the NHS and personal social services perspective and obtained from the literature and UK-based routine sources. Probabilistic distributions were assigned to the majority of model parameters so that a probabilistic analysis could be undertaken, while deterministic sensitivity analyses were also carried out to explore the impact of key parameter variation on the model results. RESULTS: Base-case results indicate that the intervention leads to cost savings (- £435) and improved effectiveness (+ 0.028 QALYs) over the patient's lifetime compared with current practice. Output from the probabilistic analysis points to a high likelihood of the intervention being cost-effective across presented willingness-to-pay (WTP) thresholds. The overall long-term cost saving for the NHS associated with the introduction of the DyeVert™ PLUS EZ system is over £19.7 million for each annual cohort of patients. The cost savings are mainly driven by a lower risk of subsequent diseases and their associated costs. CONCLUSIONS: The introduction of the DyeVert™ PLUS EZ system has the potential to reduce costs for the health care service and yield improved clinical outcomes for patients with CKD stage 3-4 undergoing angiographic procedures.

Improvement in Knowledge Level of Associate Degree Nursing Students in Zarqa University College Regarding Care for Patients With Indwelling Urinary Catheters After Joining an Educational Session.

BACKGROUND: Care for patients with indwelling urinary catheter is one of the most important factors in preventing problems associated with indwelling urinary catheters. Caregiver education about caring of indwelling urinary catheters is important the same as patient education to prevent urinary catheters problems. METHODS: A pre test post test control group design was used with nursing students of Zarqa University College. Data were collected through self-administered questionnaire. RESULTS: Experimental group did not do better in the posttest than the control group after they joined an educational session about caring for patients with indwelling urinary catheter. Level of student (first year vs. second year) has been identified as a covariate that may have distorted the results. CONCLUSION: One educational session is insufficient to change level of knowledge regarding caring for patients with indwelling urinary catheter, in addition to considering the level of nursing student when conducting the educational session.

Knowledge level assessment and change among nursing students regarding administering intra-muscular injection at Al-Balqa'a Applied University: an interventional study.

BACKGROUND: Intra-muscular injection is a widely used technique for administering parenteral medication, so education about correct techniques of administering intra-muscular injections is important to prevent complications associated with intra-muscular injection. OBJECTIVES: To assess the knowledge level of nursing students regarding administering intra-muscular injection and to determine if knowledge level change after joining an educational session about administering intra-muscular injection. DESIGNS: This study used pretest and posttest control group designs. SETTINGS: Regular class in which a pretest and an educational session was conducted followed by a posttest after 2weeks. PARTICIPANTS: Nursing students of Al-Balqa'a Applied University/Zarqa University College participated in this study. METHODS: Data were collected through self-administered questionnaire. RESULTS: Experimental group did not do better in the posttest than the control group after they joined an educational session about administering intra-muscular injection. The level of students (first year vs. second year) has been identified as a covariate that may have distorted the results. CONCLUSION: One educational session is insufficient to change level of knowledge regarding administering intra-muscular injection, in addition to considering the level of nursing students when conducting the educational session, as well as the follow up and feedback during administering intra-muscular injection at clinical sites.

Primary angioplasty for infarction due to isolated right ventricular artery occlusion.

We report an unusual case of an isolated right ventricular infarction with haemodynamic compromise caused by spontaneous isolated proximal occlusion of the right ventricular branch of the right coronary artery (RCA), successfully treated by balloon angioplasty. A 58-year-old gentleman presented with epigastric pain radiating into both arms. Electrocardiograph with right ventricular leads confirmed ST elevation in V4R and a diagnosis of isolated right ventricular infarction was made. Urgent primary percutaneous intervention was performed which revealed occlusion of the right ventricular branch of the RCA. During the procedure, the patient's blood pressure dropped to 80/40 mmHg, and echocardiography showed impaired right ventricular systolic function. Despite aggressive fluid resuscitation, the patient remained hypotensive, continued to have chest pain and persistent electrocardiograph changes, and hence balloon angioplasty was performed on the proximal right ventricular branch which restored flow to the vessel and revealed a severe ostial stenosis. This was treated with further balloon angioplasty which restored TIMI 3 flow with resolution of patient's symptoms. Repeat echocardiography showed complete resolution of the ST-elevation in leads V4R and V5R and partial resolution in V1. Subsequent dobutamine-stress echocardiography at 4 wk showed good left and right ventricular contractions. The patient was discharged after a 3-d in-patient stay without any complications.

The relationship between demographic variables and diabetes self-management in diabetic patients in Amman city/Jordan.

BACKGROUND: Diabetes is a chronic disease that requires routine and complicated self care. Although self care can be managed by most diabetes patients, there are many variables that may make diabetes self-management difficult. AIM: The study examined the relationship between clients' demographic variables and diabetes self-management in diabetic clients in Amman city/Jordan. METHOD: The data were collected through a self-completed questionnaire developed by the researchers and combined with the perceived diabetes self-management scale (PDSMS). The sampling of the investigation comprised 178 diabetes clients from Amman city/Jordan. FINDINGS: There was proportional little relationship between income level and diabetes self management, and reversely proportional low relationship between duration of diabetes and diabetes self management. Other variables had no relationship with diabetes self management. CONCLUSION: The demographic variables related to diabetes self-management in this study are income level and duration of diabetes. As income level increases, diabetes self-management become better, and the longer the duration of diabetes, the worse is diabetes self-management.

Predicting outcome in patients with left ventricular systolic chronic heart failure using a nutritional risk index.

Mortality in patients with chronic heart failure (CHF) is high and associated with body mass. However, the best method of assessing nutritional status in patients with CHF is not clear. We sought to demonstrate the prognostic use of a nutritional risk index (NRI) in ambulatory patients with CHF. Consecutive patients attending their first quarterly review appointment in the HF clinic were recruited. All patients had systolic left ventricular (LV) dysfunction. An NRI was calculated as: (1.5 × serum albumin [grams per liter]) + (current body weight/ideal weight). Patients were followed up every 4 months. Of the 538 patients enrolled in the study 75% were men. The patients' age was 71 ± 10 years (mean ± SD) and total median follow-up in survivors was 68 months (interquartile range 54 to 74). New York Heart Association classes II and III accounted for 60% and 27%, respectively, with 80% having moderate LV impairment or worse. Based on the NRI 23% of patients were at risk of malnutrition. Severely malnourished patients were older. There was no relation between NRI and LV function. The NRI was a univariable predictor of mortality (chi-square 25, p <0.001) and was an independent predictor of outcome in multivariable analysis (chi-square 12, p <0.001). In conclusion, the NRI is useful as a prognostic marker in patients with CHF in an outpatient setting. NRI might be of use as a surrogate marker for nutritional status in trials of dietary supplementation in CHF.

Chronotropic incompetence and survival in chronic heart failure.

BACKGROUND: Failure of the heart rate to rise normally during an incremental exercise test is termed chronotropic incompetence (CI). It is common in patients with chronic heart failure (CHF), and we wanted to explore the relation between CI and outcome in unselected patients with CHF. METHODS: 411 patients with left ventricular systolic dysfunction who underwent cardiopulmonary exercise testing (CPET) were included. CI was defined as a failure to achieve 80% of the maximum predicted heart rate (HR). A CI index was also calculated: (Peak HR-Rest HR)/(220-age-Rest HR)∗100. Cox regression was used to assess the univariate and multivariate relationship between variables and all-cause mortality. Survivors were followed for a median of 89months (IQR 62.8-98.6). The majority were male (81.4%) with a median age of 67years (IQR 60-73). A subgroup of 266 patients had NT-proBNP values. RESULTS: CI was present in 42.3% of the population. The mean CI index was 65.7% (SD 41.3%). Patients without CI exercised for longer (510s) and had higher peak VO(2) values (21.1mL/kg/min) than those with CI (424 seconds and 18mL/kg/min). Only peak VO(2), age and ß blocker use were independent prognostic variables. In the subset of patients with NT-proBNP available, Log[NT-proBNP] was the most powerful predictor of mortality followed by peak VO(2) and ß blocker use. CONCLUSIONS: Patients with CI had lower exercise time and peak VO(2). However CI was not a significant predictor of mortality in patients with CHF undergoing CPET.

Percutaneous intervention on anomalous circumflex coronary arteries--a single centre experience.

BACKGROUND: Anomalies of the origin and course of the circumflex artery are amongst the most common seen at coronary angiography. There is limited information regarding patient and procedural characteristics, technical feasibility and outcomes associated with percutaneous intervention (PCI) to these vessels. The aim of this study is to examine our experience with PCI to anomalous circumflex vessels and compare this to some aspects of percutaneous intervention on non-anomalous circumflex vessels. METHODS: Over a 41 month period, 20 PCI procedures on anomalous circumflex vessels were identified and 1550 PCI procedures on non-anomalous circumflex arteries. RESULTS: In 9 anomalous cases, the circumflex arose from the left coronary cusp, in 7 cases from the right coronary cusp, and in the remaining 4 cases from the proximal right coronary artery. There were no differences in demographics or pattern or severity of coronary disease between the 2 groups. A higher proportion of patients with anomalous vessels presented acutely. Screening times were longer in the anomalous group. All 20 procedures were associated with immediate procedural success. There was one peri-procedural myocardial infarction unrelated to anomalous circumflex intervention. After a median follow-up period of 7.3 months, the only major adverse cardiac event recorded in the anomalous group was an ischaemia-driven revascularisation to a non-target vessel branch. We describe techniques which can be used to improve support and facilitate successful PCI to anomalous circumflex vessels. CONCLUSION: PCI to anomalous circumflex vessels may be technically challenging, but is feasible and carries favourable short and long-term clinical outcomes. SUMMARY: This single centre observational study demonstrates that percutaneous coronary intervention to anomalous circumflex coronary arteries although technically challenging can be performed with satisfactory procedural success rates and favourable short and longer-term clinical outcomes. It describes various techniques that can be employed to optimise successful intervention.

Red cell distribution width: an inexpensive and powerful prognostic marker in heart failure.

AIMS: Red cell distribution width (RDW) is prognostic in patients with heart failure (HF), but it has not been compared with N-terminal brain natriuretic peptide (NT-proBNP). We sought to make this comparison. METHODS AND RESULTS: Patients referred to a specialist HF clinic between 2001 and 2008 were assessed comprehensively including medical history, echocardiogram, and blood tests. Cox-regression was used to assess the multivariable relationship between RDW, NT-proBNP, and all-cause mortality. A total of 1087 patients were recruited; median (IQR) follow-up was 52 months (29-66); age 72 years (64-78); 74% male; 70% ischaemic heart disease; 20% diabetic; 85% NYHA >or= 2, and 63% with at least moderate LV impairment (EF < 35% equivalent). In a multivariable model, both RDW and NT-proBNP were independently prognostic (RDW: chi(2) = 21.8 vs. 49.1 both P < 0.001). In a model using quartiles of each variable, the relative risk for each was similar for the second and third quartiles compared with the first. A larger increase in risk for NT-proBNP is seen in the fourth quartile. CONCLUSION: Red cell distribution width is a readily available test in the HF-population with similar independent prognostic power to NT-proBNP across the first to third quartiles. Prognostic models in HF should include RDW and further investigation is necessary to determine the pathological mechanism of the relationship.