Liver transplantation for hepatocellular carcinoma in Ireland:Pre-operative alpha-fetoprotein predicts tumour recurrence in a 14-year single-centre national experience

AIM: To examine the results of orthotopic liver transplantation(OLT) for hepatocellular carcinoma(HCC) in Ireland over a 14-year period.METHODS: Cases of HCC receiving OLT between January 1995 and September 2009 in the Irish Liver Transplant Unit were reviewed from a prospectively maintained database. Outcome measures included overall and recurrence free survival, alpha-fetoprotein(AFP) and tumour pathological features. RESULTS: On explant pathology, 57 patients had HCC. The median follow-up time was 42.7 mo. The overall 1, 3 and 5 years survival was 87.7%, 72.1% and 72.4%. There was no difference in survival when comparedto patients undergoing OLT without malignancy. The tumour recurrence rate was 14%. The Milan criteria were exceeded in 32% of cases but this did not predict overall survival or recurrence. On multivariate analysis pre-operative AFP > 100 ng/m L was an independent risk factor for recurrence(RR = 5.2, CI: 1.1-24.3, P = 0.036).CONCLUSION: Patients undergoing OLT for HCC had excellent survival even when conventional listing criteria were exceeded. Pre-operative AFP predicts recurrence independent of tumour size and its role in selection criteria should be investigated in larger studies.

Assessment of serum angiogenic factors as a diagnostic aid for small bowel angiodysplasia in patients with obscure gastrointestinal bleeding and anaemia

AIM To assess the use of serum levels of angiopoietin-1(Ang1), Ang2 and tumor necrosis factor-α(TNFα) as predictive factors for small bowel angiodysplasia(SBA).METHODS Serum samples were collected from patients undergoing capsule endoscopy for any cause of obscure gastrointestinal bleeding(OGIB) or anaemia. Based on small bowel findings patients were divided into 3 groups:(1) SBA;(2) other bleeding causes; and(3) normal, according to diagnosis. Using ELISA technique we measured serum levels of Ang1, Ang2 and TNFα and compared mean and median levels between the groups based on small bowel diagnosis. Using receiver operator curve analysis we determined whether any of the factors were predictive of SBA.RESULTS Serum samples were collected from a total of 120 patients undergoing capsule endoscopy for OGIB or anaemia: 40 with SBA, 40 with other causes of small bowel bleeding, and 40 with normal small bowel findings. Mean and median serum levels were measured and compared between groups; patients with SBA had significantly higher median serum levels of Ang2(3759 pg/mL) compared to both other groups, with no significant differences in levels of Ang1 or TNFα based on diagnosis. There were no differences in Ang2 levels between the other bleeding causes(2261 pg/mL) and normal(2620pg/mL) groups. Using Receiver Operator Curve analysis, an Ang2 level of > 2600 pg/mL was found to be predictive of SBA, with an area under the curve of 0.7. Neither Ang1 or TNFα were useful as predictive markers.CONCLUSION Elevations in serum Ang2 are specific for SBA and not driven by other causes of bleeding and anaemia. Further work will determine whether Ang2 is useful as a diagnostic or prognostic marker for SBA.

Risk factors for sudden cardiac death to determine high risk patients in specific patient populations that may benefit from a wearable defibrillator

BACKGROUND There is a high risk for sudden cardiac death(SCD) in certain patient groups that would not meet criteria for implantable cardioverter defibrillator(ICD) therapy.In conditions such as hypertrophic cardiomyopathy(HCM) there are clear risk scores that help define patients who are high risk for SCD and would benefit from ICD therapy. There are however many areas of uncertainty such as certain patients post myocardial infarction(MI). These patients are high risk for SCD but there is no clear tool for risk stratifying such patients.AIM To assess risk factors for sudden cardiac death in major cardiac disorders and to help select patients who might benefit from Wearable cardiac defibrillators(WCD).METHODS A literature search was performed looking for risk factors for SCD in patients post-MI, patients with left ventricular systolic dysfunction(LVSD), HCM, long QT syndrome(LQTS). There were 41 studies included and risk factors and the relative risks for SCD were compiled in table form.RESULTS We extracted data on relative risk for SCD of specific variables such as age,gender, ejection fraction. The greatest risk factors for SCD in post MI patients was the presence of diabetes [Hazard ratio(HR) 1.90-3.80], in patient with LVSD was ventricular tachycardia(Relative risk 3.50), in LQTS was a prolonged QTc(HR36.53) and in patients with HCM was LVH greater than 20 mm(HR 3.10). A proportion of patients currently not suitable for ICD might benefit from a WCDCONCLUSION There is a very high risk of SCD post MI, in patients with LVSD, HCM and LQTS even in those who do not meet criteria for ICD implantation. These patients may be candidates for a WCD. The development of more sensitive risk calculators to predict SCD is necessary in these patients to help guide treatment.

Intensive care performance: How should we monitor performance in the future?

Intensive care faces economic challenges. Therefore, evidence proving both effectiveness and efficiency, i.e., cost-effectiveness, of delivered care is needed. Today, the quality of care is an important issue in the health care debate. How do we measure quality of care and how accurate and representative is this measurement? In the following report, several topics which are used for the evaluation of intensive care unit(ICU) performance are discussed:(1) The use of general outcome prediction models to determine the risk of patients who are admitted to ICUs in an increasing variety of case mix for the different intensive care units, together with three major limitations;(2) As critical care outcomes research becomes a more established entity, mortality is now only one of many endpoints that are relevant. Mortality is a limited outcome when assessing critical care performance, while patient interest in quality of life outcomes is relevant; and(3) The Quality Indicators Committee of the Society of Critical Care Medicine recommended that short-term readmission is a major performance indicator of the quality of intensive care medicine.

A Survey of Error Analysis and Calibration Methods for MEMS Triaxial Accelerometers

MEMS accelerometers are widely used in various fields due to their small size and low cost,and have good application prospects.However,the low accuracy limits its range of applications.To ensure data accuracy and safety we need to calibrate MEMS accelerometers.Many authors have improved accelerometer accuracy by calculating calibration parameters,and a large number of published calibration methods have been confusing.In this context,this paper introduces these techniques and methods,analyzes and summarizes the main error models and calibration procedures,and provides useful suggestions.Finally,the content of the accelerometer calibration method needs to be overcome.

An Optimized Resource Scheduling Strategy for Hadoop Speculative Execution Based on Non-cooperative Game Schemes

Hadoop is a well-known parallel computing system for distributed computing and large-scale data processes.“Straggling”tasks,however,have a serious impact on task allocation and scheduling in a Hadoop system.Speculative Execution(SE)is an efficient method of processing“Straggling”Tasks by monitoring real-time running status of tasks and then selectively backing up“Stragglers”in another node to increase the chance to complete the entire mission early.Present speculative execution strategies meet challenges on misjudgement of“Straggling”tasks and improper selection of backup nodes,which leads to inefficient implementation of speculative executive processes.This paper has proposed an Optimized Resource Scheduling strategy for Speculative Execution(ORSE)by introducing non-cooperative game schemes.The ORSE transforms the resource scheduling of backup tasks into a multi-party non-cooperative game problem,where the tasks are regarded as game participants,whilst total task execution time of the entire cluster as the utility function.In that case,the most benefit strategy can be implemented in each computing node when the game reaches a Nash equilibrium point,i.e.,the final resource scheduling scheme to be obtained.The strategy has been implemented in Hadoop-2.x.Experimental results depict that the ORSE can maintain the efficiency of speculative executive processes and improve fault-tolerant and computation performance under the circumstances of Normal Load,Busy Load and Busy Load with Skewed Data.

Achieving Consensus on Continuing Professional Development Priorities for Registered Nurses in Rural and Remote India through Nominal Group Technique

Background: Nurses can often be key frontline healthcare professionals working in remote and rural settings due to resource constraints including an acute shortage of medical practitioners. The provision of regular and appropriate Continuing Professional Development (CPD) to support nurses to be able to provide effective health care therefore becomes even more significant in these settings. Engagement and “buy in” from relevant stakeholders at an organisational level is a critical step to ensure CPD provision for nurses. Objectives: The overall aim was to achieve consensus on CPD for registered nurses working in remote and rural settings among key stakeholders using the Nominal Group Technique (NGT). The objectives were to identify stakeholders’ perspectives on the priorities for CPD training for registered nurses;the preferred modes of delivery for CPD and perceived barriers and facilitators for CPD access. Methods: NGT was used as a qualitative method with key organisational stakeholders in several iterative stages in the form of a workshop. Results: 22 senior healthcare professionals involved in medical and nursing education representing north, northeast, central India and the state of Karnataka in South India participated in the workshop. Three key findings emerged from this study: priorities of CPD;preferred modes of CPD delivery;barriers and facilitators to CPD access. Conclusion: Engagement with key stakeholders to identify CPD priorities can help facilitate strategic planning and provision of relevant and accessible CPD programmes for nurses working within remote and rural health care contexts in India.

Widening the perspectives of fracture prevention in osteoporosis by identifying subgroups based upon psychological aspects and health behaviour

The potential importance of psychological aspects in relation to risk factors for fractures and preventing unhealth behaviour has rarely been investigated in the field of osteoporosis. This study explores some psychological aspects and health behaviour of people detected to have osteoporosis at the time of a forearm fracture. Moreover, it aims at revealing subgroups within this population with clinical relevance for managing secondary prevention actions. Data collection was based on questionnaires and physical tests. Eighty-five individual were analysed. The results confirm earlier research on a similar population having relatively good self-reported health behaviour. The individuals reported high quality of life, high amount of physical activity and low alcohol intake. A majority reported good osteoporosis knowledge, a high sense of coherence (mean = 74) and high activity-specific balance confidence (mean = 81). Furthermore, hierarchical cluster analysis indicated a typology of two subgroups where 75% matched a health-resilient group while 25% matched a health-vulnerable group. The vulnerable group had a significantly lower sense of coherence SOC (p = 0.02) and activity-specific balance confidence, ABC (p = 0.001). This pattern was confirmed from behavioural aspects but only regarding one traditional risk factor namely the history of fractures. The health-vulnerable group achieved a significantly weaker physical profile, less reported time spent outdoors and lower quality of life. The differences found between the subgroups indicate that this typology, as a complement to models based upon relative risk like FRAX, can be relevant for widening perspectives in future research and clinical practice of fracture prevention in osteoporosis.

足踝步态模拟机动力学特性仿真及实验验证

目的研究足踝步态模拟机动力学特性,仿真着地相中的足底垂直、前后、水平3个足底反力,并在实验台中验证。方法运用设计的5自由度步态模拟机,建立Adams虚拟样机和足踝模型(包含足部主要韧带和跖腱膜、足底软组织及跟腱力),对其进行动力学仿真,并把仿真中的控制规律运用到实验台验证;将仿真和实验中测力板测得的足底反力与仿真和真实数据比较。结果着地相进程中3个方向的足底反力与实际步态中吻合度较高,足部的韧带和跖腱膜、跟腱和软组织等对正确的步态有重要的影响,步态实验台能够很好重复仿真特性。结论模拟机具备仿真人体步态着地相的能力,为活体无法进行测量的实验提供临床研究平台。

正走和倒走的膝关节生物力学特征比较

目的比较正走和倒走两种不同行走模式时膝关节的生物力学特征。方法采用三维运动捕捉系统Vicon T40和测力台AMTI OR6-7采集并比较13名健康青年男性志愿者正走和倒走时的时间、空间、运动学和动力学参数。结果与正走相比,倒走时的步速、步频和步幅均显著减小,跨步周期和支撑相所占百分比显著增加;在矢状面上,倒走时膝关节活动度、最大屈伸力矩较正走小;在冠状面上,倒走时膝关节内翻外展活动范围也较正走小,内翻力矩峰值在支撑早期较正走小,但在支撑晚期较正走大;地面反作用力在支撑早期较正走大,但在支撑晚期较正走小。结论倒走和正走膝关节生物力学特征差异明显。与正走相比倒走在支撑相早期能减轻膝关节内侧间室的负荷,而倒走在支撑相晚期对膝关节负荷的影响则尚须进一步研究。

α-葡萄糖苷酶抑制剂治疗2型糖尿病的系统评价(英文)

目的评价α-葡萄糖苷酶抑制剂治疗2型糖尿病患者的效果。方法检索Cochrane图书馆、MEDLINE、EMBASE、CurrentContents、LILACS在研试验数据库,主题为α-葡萄糖苷酶抑制剂的综述的参考文献,并联系纳入试验的专家与实施者。最近检索日期为2003年月12月(CurrentContents)和2003年4月(其他数据库)。纳入α-葡萄糖苷酶抑制剂单一疗法与其它干预比较,治疗2型糖尿病疗程至少12周的随机对照试验,并且试验至少包括以下结局之一:病死率、患病率、生活质量、血糖控制、血脂、胰岛素水平、体重、不良事件。两名评价者独立阅读所有摘要,评价质量并提取数据,分歧通过协商解决或由第三位评价者裁决。由一位统计学家在对提取数据输入数据库时进行检查。我们尽量联系所有作者以核实数据。结果共纳入41个试验、8130例受试者,其中30个针对阿卡波糖,7个针对米格列醇,1个针对优格列波糖,还有3个为不同α-葡萄糖苷酶抑制剂间的比较。绝大多数研究疗程为24周,仅有2个研究超过1年。与安慰剂相比,阿卡波糖血糖控制效果更好:糖化血红蛋白–0.8%[95%CI(–0.9,–0.7)],空腹血糖–1.1mmol/L[95%CI(–1.4,–0.9)],负荷血糖–2.3mmol/L[95%CI(–2.7,–1.9)],阿卡波糖对糖化血红蛋白的作用呈非剂量依赖。我们发现其可降低负荷胰岛素,但对血脂和体重未见临床相关的作用。不良反应主要来自胃肠道且与剂量相关。相对于磺脲,阿卡波糖将空腹和负荷胰岛素水平分别降低至–24.8pmol/L[95%CI(–43.3,–6.3)]和–133.2pmol/L[95%CI(–184.5,–81.8)],但阿卡波糖引起的不良反应更多。结论关于α-葡萄糖苷酶抑制剂是否影响2型糖尿病患者的病死率和患病率仍不清楚。相反,其对血糖控制或胰岛素水平作用明显,对血脂和体重的作用差异无统计学意义。α-葡萄糖苷酶抑制剂更长疗程的效果仍不确定。阿卡波糖剂量超过50mg(TID)时不能进一步影响糖化血红蛋白水平,不良反应反而更多,与磺脲相比,α-葡萄糖苷酶抑制剂降低了空腹和负荷胰岛素水平,但在血糖控制和不良反应方面存在不利影响。

Chronic pancreatitis:A diagnostic dilemma

Typical clinical symptoms of chronic pancreatitis are vague and non-specific and therefore diagnostic tests are required, none of which provide absolute diagnostic certainly, especially in the early stages of disease. Recently-published guidelines bring much needed structure to the diagnostic work-up of patients with suspected chronic pancreatitis. In addition, novel diagnostic modalities bring promise for the future. The assessment and diagnosis of pancreatic exocrine insufficiency remains challenging and this review contests the accepted perspective that steatorrhea only occurs with > 90% destruction of the gland.

Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome

AIM To determine the placebo response rate associated with different types of placebo interventions used in psychological intervention studies for irritable bowel syndrome. METHODS Randomized controlled trials comparing psychological interventions(stress management/relaxation therapy(cognitive) behavioral therapy, short-term psychodynamic therapy, and hypnotherapy) for the treatment of adult patients with irritable bowel syndrome(IBS) diagnosed with the Manning or Rome criteria with an adequate placebo control treatment and reporting data on IBS symptom severity were identified by searching Pub Med, Embase, the Cochrane Library, CINAHL and Psyc INFO databases. Full-text articles that were written in English and published between 1966 and February 2016 in peer-reviewed journals were selected for the present review. Placebo interventions were considered to be adequate if the number of sessions and the amount of time spent with the therapist were the same as in the active treatment. The placebo response rate(PRR) was computed for IBS symptom severity(primary outcome measure) as well as for anxiety, depression and quality of life(secondary outcome measures). RESULTS Six studies, with a total of 555 patients met the inclusion criteria. Four studies used an educational intervention, whereas two studies used a form of supportive therapy as the placebo intervention. The PRR for IBS symptom severity ranged from 25% to 59%, with a pooled mean of 41.4%. The relative PRR for the secondary outcome measures ranged from 0% to 267% for anxiety, 6% to 52% for depression 20% to 125% for quality of life. The PRR associated with pharmacological treatments, treatment with dietary bran and complementary medicine ranged from 37.5% to 47%. Contrary to our expectations, the PRR in studies on psychological interventions was comparable to that in studies on pharmacological, dietary and alternative medical interventions.CONCLUSION The PRR is probably determined to a larger extent by patient-related factors, such as expectations and desire for the treatment to be effective, than the content of the placebo intervention.

Small bowel Dieulafoy lesions: An uncommon cause of obscure bleeding in cirrhosis

Dieulafoy lesions(DLs) are an uncommon cause of gastrointestinal bleeding, accounting for up to 2% of cases overall. They are largely under recognised and difficult to treat. Up to 95% occur in the stomach, and only case reports document their occurrence in the small bowel(SB). Little is known about their pathophysiology, although there have been associations made previously with chronic liver disease, thought to be due to the erosive effects of alcohol on the mucosa overlying the abnormally dilated vessels. We present a case series of 4 patients with a long duration of obscure gastrointestinal bleeding, who were diagnosed with small intestinal DLs and incidentally diagnosed with chronic liver disease. The histories describe the challenges in both diagnosis and treatment of small intestinal DLs. Our case series suggest a previously unreported link between chronic liver disease and SB DLs which may be due to anatomical vasculature changes or a shift in angiogenic factors as a consequence of portal hypertension or liver cirrhosis.

Slacklining and stroke: A rehabilitation case study considering balance and lower limb weakness

To ascertain the effectiveness of slacklining as a supplementary therapy for elderly stroke patients who are functionally non-progressing. This case study involved an 18-mo prospective observation of the management of an 87-year-old female stroke-patient of the left hemisphere with reduced balance, reduced lower limb muscular activation, hypertonia, and concurrent postural deficits. This entailed the initial acute care phase through to discharge to home and 18-mo final status in her original independent living setting. The introduction of slacklining as an adjunct therapy was made 12 mo post incident. Slacklining involves balance retention on a tightened band where external environmental changes cause a whole-body dynamic response to retain equilibrium. It is a complex neuromechanical task enabling individualized self-developed response strategies to be learned and adapted. This facilitates the innate process of balance retention, lower-limb and core muscle activation, and stable posture through a combination of learned motor skills and neurological system down regulation. Individuals adopt and follow established sequential motor learning stages where the acquired balance skillsare achieved in a challenging composite-chain activity. Slacklining could be considered an adjunct therapy for lower limb stroke rehabilitation where function is compromised due to decreased muscle recruitment, decreased postural control and compromised balance. Initial inpatient rehabilitation involved one-month acute-care, one-month rehabilitation, and one-month transitional care prior to home discharge. A further six months of intensive outpatient rehabilitation was provided with five hourly sessions per week including:supervised and self-managed hydrotherapy, plus one individual and two group falls' prevention sessions. These were supported by daily home exercises. At 12 mo post incident, recovery plateaued, then regressed following three falls. Rehabilitation was subsequently modified with the hydrotherapy retained and the group sessions replaced with an additional individual session supplemented with slacklining. The slacklining followed stages one and two of a standardized five-stage protocol. Self-reported functional progression resumed with improvement by 14 mo which further increased and was sustained 18 mo(Students' t test P < 0.05). Slacklining's external stimulations activate global-body responses through innate balance, optimal postural and potentially down-regulated reflex control. Incorporated into stroke rehabilitation programs, slacklining can provide measurable functional gains.

A Survey of Lower Limb Rehabilitation Systems and Algorithms Based on Functional Electrical Stimulation

Functional electrical stimulation is a method of repairing a dysfunctional limb in a stroke patient by using low-intensity electrical stimulation.Currently,it is widely used in smart medical treatment for limb rehabilitation in stroke patients.In this paper,the development of FES systems is sorted out and analyzed in a time order.Then,the progress of functional electrical stimulation in the field of rehabilitation is reviewed in details in two aspects,i.e.,system development and algorithm progress.In the system aspect,the development of the first FES control and stimulation system,the core of the lower limb-based neuroprosthesis system and the system based on brain-computer interface are introduced.The algorithm optimization for control strategy is introduced in the algorithm.Asynchronous stimulation to prolong the function time of the lower limbs and a method to improve the robustness of knee joint modeling using neural networks.Representative applications in each of these aspects have been investigated and analyzed.

已确诊心血管疾病患者的颈动脉硬度与新发血管事件风险:SMART研究

Aims: To study whether arterial stiffness is related to risk of new vascular events in patients with manifest arterial disease and to examine whether this relation varies between patients who differ with respect to baseline vascular risk, arterial stiffness, or systolic blood pressure(SBP). Methods and results: The study was performed in the first consecutive 2183 patients with manifest arterial disease enrolled in the SMART study(Second Manifestations of ARTerial disease), a cohort study among patients with manifest arterial disease or cardiovascular risk factors. Common carotid distension(i.e. the change in carotid diameter in systole relative to diastole) was measured at baseline by ultrasonography. With the distension, several stiffness parameters were determined. In the entire cohort, none of the carotid artery stiffness parameters was related to the occurrence of vascular events. However, decreased stiffness was related to decreased vascular risk in subjects with low baseline SBP. The relation of carotid stiffness with vascular events did not differ between tertiles of baseline risk and carotid stiffness. Conclusion: Carotid artery stiffness is no independent risk factor for vascular events in patients with manifest arterial disease. However, in patients with low SBP, decreased carotid stiffness may indicate a decreased risk of vascular events.

The effects of exposure to pesticides on the fecundity status of farm workers resident in a rural region of Fars province,southern Iran

Objective:To investigate the prevalence of fecundity and other reproductive problems among a group of farmers in Kavar district of Fars province,southern Iran.Methods:A total of 268 randomly selected married male farm workers were investigated.A questionnaire was devised and validated[Cronbach'sα-coefficient(0.81)].Subjects were directly interviewed and the questionnaire forms were completed for them.Results:The prevalence of current primary infertility aniong the studied population was about7.4%(P=0.001).Similarly,6.3%of farm workers had offsprings with congenital malformations.Finally,1.5%and 9%of farmers'wives had a history of stillbirth and abortion,respectively.It was concluded that the prevalence of current primary infertility were higher aniong farm workers families than in the normal population(P<0.05).Additionally,stillbirth and spontaneous abortion were more common in the wives of farm workers than in the normal population,although the difference did not reach statistical significance.Conclusions:These effects are likely to be attributed to the exposure of farm workers to pesticides.

Seroepidemiology of Toxoplasma infection in blood donors in Jahrom District,Southern Iran

Objective:To identify the anti-Toxoplasma antibodies from blood donors who referred to blood transfusion bases of Jahrom County,using ELISA method.Methods:Based on the prevalence and characteristics method,400 serum samples were collected from blood donors referred to Jahrom blood transfusion bases,Southern Iran,during 2010–2011,designed at testing by ELISA.Ig M and Ig G antibodies against Toxoplasma gondii were tested using ELISA kits(Dia-Pro)on serums.The data were analysed by SPSS 19 software.Results:Review of 400 cases,54 of them were Ig G positive for parasites(13.5%)and 346of those with negative Ig G(86.5%).In Ig M examination,1.75%of them have been positive Ig M(7 cases)and 98.25%of them were Ig M negative(393 cases).By comparing the different group ages,40–50 year age group had the highest prevalence of Ig G positive(17.9%)and the age group of 30–40 years had the highest incidence of Ig M negative(2.5%).Conclusions:Due to the serological infection rate of toxoplasmosis obtained from this study,toxoplasmosis should be considered as a significant transfusion risk factor in Jahrom and also in any region with similar situations.

Continuing Professional Development: Needs, Facilitators and Barriers of Registered Nurses in India in Rural and Remote Settings: Findings from a Cross Sectional Survey

Background: Nurses constitute a major portion of the health care workforce in India. A priority to develop pre and post registration nurse education in India has increasingly been highlighted in nursing and health policy imperatives in recent years. Nurses are often the only health care professionals in primary and secondary care within rural and remote healthcare settings in India. They are confronted with the dual challenge of resource constraints and rapidly changing disease profile with little or no access to continuing professional development. Objectives: 1) To identify key continuing professional development priorities of registered nurses working in remote and rural health care settings in India. 2) To identify barriers and facilitators to continuing professional development as perceived by registered nurses working in these settings. 3) To identify preferred modes of continuing professional development by registered nurses working in remote and rural health care settings in India. Design: Quantitative Design. Setting: Two large health care facilities in remote and rural parts of India. Participants: Registered Nurses working in two large not for profit health care organisations participated in the study. Nursing assistants and student nurses were excluded from the study. 368 participants consented to participate in the survey and 271 (73.6%) participants completed the survey. Methods: A questionnaire based cross sectional survey was undertaken as part of the Continuing Professional Development needs assessment among registered nurses working in rural and remote settings. Results: Continuing Professional Development priorities included training on clinical competencies focussed on managing emergency situations related to non-communicable diseases [50%], managerial competencies related to ethical dilemmas [60%] such as support for families with financial difficulties accessing health care [17.8%], women undergoing abortions [14.6%], or those with HIV infection [12.9%]. Preferred modes for Continuing Professional Development included conference attendance [54%], skills training [48%] and in-house training [32%]. Key facilitators for Continuing Professional Development included, professional development [77%], personal interest [42%], opportunities for professional engagement with colleagues [39%], the need to reduce knowledge and skill gap [36%] and career progression [28%]. Geographic distance [59%], low staffing levels [51%], cost [43%], domestic responsibilities [40%], and work commitments [39%] were reported as key barriers to Continuing Professional Development. Conclusions: The findings from this survey, the first of its kind in India, provides evidence on priorities, barriers and facilitators for continuing professional development of registered nurses working in rural and remote settings in India.