No abstract

BackgroundSodium‐glucose cotransporter 2 (SGLT2) inhibitors are a novel class of antihyperglycemic agents that improve glycemic control by increasing glycosuria. Additional benefits beyond glucose lowering include significant improvements in seated clinic blood pressure (BP), partly attributed to their diuretic‐like actions. Less known are the effects of this class on 24‐hour ambulatory BP, which is a better predictor of cardiovascular risk than seated clinic BP.Methods and ResultsWe performed a meta‐analysis of randomized, double‐blind, placebo‐controlled trials to investigate the effects of SGLT2 inhibitors on 24‐hour ambulatory BP. We searched all studies published before August 17, 2016, which reported 24‐hour ambulatory BP data. Mean differences in 24‐hour BP, daytime BP, and nighttime BP were calculated by a random‐effects model. SGLT2 inhibitors significantly reduce 24‐hour ambulatory systolic and diastolic BP by −3.76 mm Hg (95% CI, −4.23 to −2.34; I2=0.99) and −1.83 mm Hg (95% CI, −2.35 to −1.31; I2=0.76), respectively. Significant reductions in daytime and nighttime systolic and diastolic BP were also found. No association between baseline BP or change in body weight were observed.ConclusionsThis meta‐analysis shows that the reduction in 24‐hour ambulatory BP observed with SGLT2 inhibitors is a class effect. The diurnal effect of SGLT2 inhibitors on 24‐hour ambulatory BP may contribute to their favorable effects on cardiovascular outcomes.

No abstract

No abstract

This paper presents the first-known review of the measurement properties for the cognitive frailty construct since the published results from the International Consensus Group (I.A.N.A/I.A.G.G). Evidence presented in this review continues to support the link between physical frailty and cognition with developing validity to support distinct relationships between components of physical frailty and cognitive decline. Results call attention to inconsistencies in reporting of reliability, validity, and heterogeneity in the measurements and operational definition for cognitive frailty. Further research is needed to establish an operational definition and develop psychometrically appropriate clinical measures to construct an understanding of the relationship between physical frailty and cognitive decline.

Two experiments were conducted at three locations to determine the correct dosage and carrier for trenbolone acetate (TBA) and estradiol (E2) implants in feedlot steers. In the dose-response experiment, 1,296 steers were allotted to six implant treatments (48 pens per location): control, 140 mg of TBA (140/0), 30 mg of E2 (0/30), 20 mg of TBA + 4 mg of E2(20/4), 80 mg of TBA + 16 mg of E2(80/16), and 140 mg of TBA + 28 mg of E2 (140/28). In the carrier experiment, 575 steers were allotted to five implant treatments (25 pens per location): control, 140 mg of TBA + 28 mg of E2 in lactose (140/28-LA), 140 mg of TBA + 28 mg of E2 in cholesterol (140/28-CH), 140 mg of TBA + 20 mg of E2 in LA (140/20-LA), and 200 mg of progesterone + 20 mg of E2 benzoate (SS, reimplanted). In both experiments steers were fed a finishing diet for 140 to 168 d. In the dose-response experiment, response to TBA alone (140/0) did not differ from control (P greater than .2). Estradiol alone (0/30) improved ADG by 7% (P less than .01) and tended to improve feed efficiency over control (3%, P = .17). The highest dosage (140/28) improved ADG by 18% (P less than .001) and feed efficiency by 10% (P less than .001) over control and 10% (P less than .001) and 7% (P less than .01) over E2 alone, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The need for improved methods for the determination and characterization of the protein components of human blood plasma requires no emphasis. The commonly employed methods for the separation of plasma proteins on the basis of solubility give little detailed information and generally yield poor separations (1). Likewise, the method of electrophoretic analysis, although of unquestioned value, will fail to differentiate between components of widely differing chemical properties and physiological functions if they happen to have the same mobility in an electric field.The present communication describes the adaptation of Method 10 of plasma fractionation developed by Cohn and his associates (2) for the quantitative estimation of certain of the protein and lipoprotein components in small quantities of normal human plasma. The fractionation is carried out at low temperatures using low concentrations of ethanol and of various salts, resulting in the concentration of each protein component

Background Evidence‐based practice and decision‐making have been consistently linked to improved quality of care, patient safety, and many positive clinical outcomes in isolated reports throughout the literature. However, a comprehensive summary and review of the extent and type of evidence‐based practices (EBPs) and their associated outcomes across clinical settings are lacking. Aims The purpose of this scoping review was to provide a thorough summary of published literature on the implementation of EBPs on patient outcomes in healthcare settings. Methods A comprehensive librarian‐assisted search was done with three databases, and two reviewers independently performed title/abstract and full‐text reviews within a systematic review software system. Extraction was performed by the eight review team members. Results Of 8537 articles included in the review, 636 (7.5%) met the inclusion criteria. Most articles (63.3%) were published in the United States, and 90% took place in the acute care setting. There was substantial heterogeneity in project definitions, designs, and outcomes. Various EBPs were implemented, with just over a third including some aspect of infection prevention, and most (91.2%) linked to reimbursement. Only 19% measured return on investment (ROI); 94% showed a positive ROI, and none showed a negative ROI. The two most reported outcomes were length of stay (15%), followed by mortality (12%). Linking Evidence to Action Findings indicate that EBPs improve patient outcomes and ROI for healthcare systems. Coordinated and consistent use of established nomenclature and methods to evaluate EBP and patient outcomes are needed to effectively increase the growth and impact of EBP across care settings. Leaders, clinicians, publishers, and educators all have a professional responsibility related to improving the current state of EBP. Several key actions are needed to mitigate confusion around EBP and to help clinicians understand the differences between quality improvement, implementation science, EBP, and research.