The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

正しい方法がわかる臨床基本手技 : from the New England journal of medicine

Obesity and the risk of heart failure

A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease☆

Background
hyperlipidemia as a major risk factor of atherosclerosis is treated with different drugs. Concerning length of therapy and vast majority of side effects, herbal medication may be suitable substitute for these drugs.

/pdf/effects-of-anethum-graveolens-and-garlic-on-lipid-profile-in-26p5x4d6nz.pdf

Effects of anethum graveolens and garlic on lipid profile in hyperlipidemic patients.

Many patients experience anxiety and depression after cardiac bypass surgery. The aim of this study was to examine the effect of cardiac rehabilitation on anxiety and depression in patients undergoing coronary artery bypass grafting in hospitals affiliated to Shiraz University of Medical Sciences in southern Iran. For this randomized controlled trial, 80 patients who met the inclusion criteria were recruited and randomly assigned to case and control groups. Anxiety was measured with the Spielberger Anxiety Scale and depression was measured using Beck’s Depression Inventory at three points in time: on discharge from the hospital, immediately after the intervention, and 2 months after cardiac rehabilitation. After measuring anxiety and depression in both groups upon discharge, the experimental group participated in 8 cardiac rehabilitation sessions over a 4-week period. The control group received only the routine follow-up care. There was a statistically significant difference in depression scores between groups at all three time-points (Mean score from 19.6 to 10 in the intervention group and from 19.5 to 14 in the control group, P = 0.0014). However, no significant difference was seen in anxiety scores between the groups (Mean score from 37 to 28 in the intervention group and from 38 to 32 in the control group, P = 0.079). Cardiac rehabilitation was effective in reducing depression 2 months after surgery in patients undergoing coronary artery bypass grafting. IRCTN201203262812N8

/pdf/the-effect-of-cardiac-rehabilitation-on-anxiety-and-2itbnfq4do.pdf

The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypass graft surgery in Iran

Background: The purpose of this qualitative exploratory study was to explore the views of nursing trainers and students about nursing students’ clinical evaluation problems and drawbacks in Shiraz Nursing and Midwifery School. Materials and Methods: A qualitative exploratory approach was used in this study at Shiraz Nursing and Midwifery School in 2012. A purposeful sample of 8 nursing instructors and 40 nursing students was interviewed and the data on their opinions about the problems of the clinical evaluation were collected through semi-structured deep interviews. Initially, four open-ended questions, which were related to the clinical evaluation status, problems, were used to stimulate discussions in the interview sessions. Content analysis was employed in order to analyze the transcribed data. The recorded interviews were initially transcribed, read, and reread on a number of occasions to get an overall feeling of what the participants were saying. Each line or incident was described, and then a code, which refl ected the essence of the participants’ comments, was given. Results: The codes were compared for similarity and differences, merged together, and categorized. Finally, fi ve themes emerged: In appropriate clinical evaluation method, problems of clinical evaluation Process, problems related to clinical instructors, unsuitable programming of clinical education, and organizational shortcomings. Conclusion: Besides focusing on upgrading the current clinical evaluation forms, nursing trainers should improve their knowledge about a complete and comprehensive clinical evaluation. They should also apply other appropriate and objective clinical evaluation methods and tools, and perform a formative and summative clinical evaluation. Also, workload adjustment of the nursing trainers needs revision. Therefore, despite using traditional and sometimes limited evaluation methods for assessing nursing students, a co mprehensive and appropriate evaluation of nursing students’ clinical competencies seems necessary.

http://www.ijnmr.mui.ac.ir/index.php/ijnmr/article/download/990/710

Problems and challenges of nursing students' clinical evaluation: A qualitative study.

Background: Myocardial infarction remains one the leading causes of mortality and morbidity and involves a high cost of care. Early prediction can be helpful in preventing the development of myocardial infarction with appropriate diagnosis and treatment. Artificial neural networks have opened new horizons in learning about the natural history of diseases and predicting cardiac disease. Methods: A total of 935 cardiac patients with chest pain and nondiagnostic electrocardiogram (ECG) were enrolled and followed for 2 weeks in two groups based on the appearance of myocardial infarction. Two types of data were used for all patients: nominal (clinical data) and quantitative (ECG findings). Two different artificial neural networks – radial basis function (RBF) and multi-layer perceptron (MLP) – were used to classify the two groups. Results: The RBF neural network had an accuracy of 83% with ECG findings and an accuracy of 78% with clinical features. When and clinical data were used in an MLP neural network trained with a genetic algorithm, ECG results led to a classification accuracy of 96% and clinical data yielded an accuracy of 84.5%. Conclusion: Both neural network structures predicted MI within about 2 weeks of hospital referral with an acceptable degree of accuracy in patients with nondiagnostic ECG. The MLP neural network significantly outperformed the RBF network because of the use of the genetic algorithm, which provided a global strategy to accurately determine MLP weights (clinical trials registry: NCT01870258). Key words: Artificial neural networks, Electrocardiography, Myocardial infarction, Multi-layer perceptron (MLP), Radial basis function (RBF).

Prediction of acute myocardial infarction with artificial neural networks in patients with nondiagnostic electrocardiogram

Introduction: In the past 2 decades, research findings established achievementgoal theory as a powerful framework for conceptualizing difference in thequality of student’s engagement, persistence on task, and academic resilience.So the present study examined the relationship between achievement goalorientations and academic resilience.Method: Participants were 606 students (307 girls and 297 boys) selected fromShiraz high schools. They completed the Achievement Goals Questionnaireand Youth development Module Scale (RYDM). To analyze the data, therelationships between variables were examined, using Pearson product–moment correlations. Also simulanteous multiple regression was performedto investigate the prediction of academic resilience by achievement goalorientations. To examine the reliability and the validity of measures Cronbachalpha coefficient and factor analysis method were applied, respectively.Results: Simultaneous multiple regression of achievement goal orientationson academic resilience showed that “mastery-approach” was a significantpositive predictor of the “home care/high” and “peer care” subscales. Also,“performance-approach” was a significant, positive predictor of “home care/high”, and “school/community meaningful” was predicted by “performanceavoidance”positively.Conclusion: According to the findings, it seems that achievement goalorientation has a critical role in students’ academic achievement. Implications of the results are discussed in more details.Keywords: Resilience, Education, Goal orientation

https://jamp.sums.ac.ir/article_40887_bb85f9f36d047bba9c983cec4d852c76.pdf

Javad Kojuri

Papers

Effects of anethum graveolens and garlic on lipid profile in hyperlipidemic patients.

The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypass graft surgery in Iran

Problems and challenges of nursing students' clinical evaluation: A qualitative study.

Prediction of acute myocardial infarction with artificial neural networks in patients with nondiagnostic electrocardiogram

Academic resilience in education: the role of achievement goal orientations