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NHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40-74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. Currently, the QRISK®2 10-year CVD risk score is most common way in which CVD risk is estimated. Newer tools, such as JBS3, allow manipulation of risk factors and can demonstrate the impact of positive actions. However, the use, and relative value, of these tools within CVD risk communication is unknown. We will explore practitioner and patient CVD risk perceptions when using QRISK®2 or JBS3, the associated advice or treatment offered by the practitioner, and patients' responses. ⋯ This study will produce novel insights about the utility of QRISK®2 and JBS3 to promote patient and practitioner understanding and perception of CVD risk and associated implications for patient intentions with respect to health-protective behaviours (and underlying mechanisms). Recommendations for practice will be developed.
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IEEE Trans Biomed Eng · Jul 2006
Simulation analysis of conduction block in myelinated axons induced by high-frequency biphasic rectangular pulses.
Nerve conduction block induced by high-frequency biphasic rectangular pulses was analyzed using a lumped circuit model of the myelinated axon based on Frankenhaeuser-Huxley (FH) equations. At the temperature of 37 degrees C, axons of different diameters (2-20 microm) can be blocked completely at supra-threshold intensities when the stimulation frequency is above 10 kHz. However, at stimulation frequencies between 6 kHz and 9 kHz, both nerve block and repetitive firing of action potentials can be observed at different stimulation intensities. ⋯ Larger diameter axons have a lower threshold intensity to induce conduction block. When temperature is reduced from 37 degrees C to 20 degrees C, the lowest frequency to completely block large axons (diameters 10-20 microm) decreased from 8 kHz to 4 kHz. This simulation study can guide future animal experiments as well as optimize stimulation waveforms for electrical nerve block in clinical applications.
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Anaesthesiol Intensive Ther · Jan 2018
ReviewPoint-of-care gastrointestinal and urinary tract sonography in daily evaluation of gastrointestinal dysfunction in critically ill patients (GUTS Protocol).
There is currently a lack of universally accepted criteria for gastrointestinal (GI) failure or dysfunction in critical care. Moreover, the clinical assessment of intestinal function is notoriously difficult and thus often goes unrecognized, contributing to poor outcomes. A recent grading system has been proposed to define acute gastrointestinal injury (AGI) in conjunction with other organ function scores (e.g., SOFA). ⋯ Moreover, it is possible to examine the urinary tract and kidney function. Real-time ultrasound with the GUTS protocol is a simple, inexpensive, bedside imaging technique that can provide anatomical and functional information of the GI tract. Further studies are needed to investigate the utility of GUTS with other parameters, such as GI biomarkers, AGI class, and clinical outcomes.
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Non-contrast computed tomography (NCCT) is the diagnostic choice for renal stone disease. Knowing the composition of a stone before passage can help to choose a better management. We sought to determine whether the Hounsfield unit (HU) measured by NCCT can predict the composition. ⋯ NCCT can differentiate just Calcium from non-calcium stones.
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Randomized Controlled Trial Multicenter Study
The effects of medical management on the progression of diabetic retinopathy in persons with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study.
To report additional ocular outcomes of intensive treatment of hyperglycemia, blood pressure, and dyslipidemia in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. ⋯ Slowing of progression of retinopathy by intensive treatment of glycemia was observed in ACCORD participants, whose average age and diabetes duration were 62 and 10 years, respectively, and who had cardiovascular disease or cardiovascular risk factors. The effect seemed stronger in patients with mild retinopathy. Similar slowing of progression was observed in patients treated with fenofibrate, with no effect observed with intensive blood pressure treatment. This is the second study to confirm the benefits of fenofibrate in reducing diabetic retinopathy progression, and fenofibrate should be considered for treatment of diabetic retinopathy.