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Sample records for patients exclusion criteria

  1. Real-life Use of Anticoagulants in Venous Thromboembolism With a Focus on Patients With Exclusion Criteria for Direct Oral Anticoagulants.

    Science.gov (United States)

    Moustafa, Farès; Pesavento, Raffaele; di Micco, Pierpaolo; González-Martínez, José; Quintavalla, Roberto; Peris, Maria-Luisa; Porras, José Antonio; Falvo, Nicolas; Baños, Pilar; Monreal, Manuel

    2018-04-01

    We assessed the real-life use of direct oral anticoagulants (DOACs) in patients with venous thromboembolism (VTE) and exclusion criteria for randomized trials. From 2013 to 2016, 3,578 of 18,853 patients (19%) had exclusion criteria. Irrespective of which anticoagulant was chosen, they had more VTE recurrences (hazard ratio (HR): 3.10; 95% confidence interval (CI): 2.47-3.88), major bleeds (HR: 4.10; 95% CI: 3.38-4.96), and deaths (HR: 9.47; 95% CI: 8.46-10.6) than those without exclusion criteria. During initial therapy, no patient with exclusion criteria on DOACs (n = 115) recurred, but those on rivaroxaban bled less often (adjusted HR: 0.18; 95% CI: 0.04-0.79) than those on unfractionated heparin (n = 224) and similar to those (n = 3,172) on low-molecular-weight (LMWH) heparin. For long-term therapy, patients on rivaroxaban (n = 151) had nonsignificantly fewer VTE recurrences (adjusted HR: 0.74; 95% CI: 0.08-1.32) and major bleeds (adjusted HR: 0.41; 95% CI: 0.15-1.15) than those on LMWH (n = 2,071). The efficacy and safety of DOACs were similar to standard therapy. © 2017 American Society for Clinical Pharmacology and Therapeutics.

  2. Alpha-fetoprotein level > 1000 ng/mL as an exclusion criterion for liver transplantation in patients with hepatocellular carcinoma meeting the Milan criteria.

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    Hameed, Bilal; Mehta, Neil; Sapisochin, Gonzalo; Roberts, John P; Yao, Francis Y

    2014-08-01

    Serum alpha-fetoprotein (AFP) has been increasingly recognized as a marker for a poor prognosis after liver transplantation (LT) for hepatocellular carcinoma (HCC). Many published reports, however, have included a large proportion of patients with HCC beyond the Milan criteria, and the effects of incorporating AFP as an exclusion criterion for LT remain unclear. We studied 211 consecutive patients undergoing LT for HCC within the Milan criteria according to imaging under the Model for End-Stage Liver Disease organ allocation system between June 2002 and January 2009. The majority (93.4%) had locoregional therapy before LT. The median follow-up was 4.5 years (minimum = 2 years). The Kaplan-Meier 1- and 5-year patient survival rates were 94.3% and 83.4%, respectively. In a univariate analysis, significant predictors of HCC recurrence included vascular invasion [hazard ratio (HR) = 10, 95% confidence interval (CI) = 3.9-26, P 1000 ng/mL (HR = 4.5, 95% CI = 1.3-15.3, P = 0.02), and an AFP level > 500 ng/mL (HR = 3.1, 95% CI = 1.04-9.4, P = 0.04). In a multivariate analysis, vascular invasion was the only significant predictor of tumor recurrence (HR = 5.6, 95% CI = 1.9-19, P = 0.02). An AFP level > 1000 ng/mL was the strongest pretransplant variable predicting vascular invasion (odds ratio = 6.8, 95% CI = 1.6-19.1, P = 0.006). The 1- and 5-year rates of survival without recurrence were 90% and 52.7%, respectively, for patients with an AFP level > 1000 ng/mL and 95% and 80.3%, respectively, for patients with an AFP level ≤ 1000 ng/mL (P = 0.026). Applying an AFP level > 1000 ng/mL as a cutoff would have resulted in the exclusion of 4.7% of the patients fr m LT and a 20% reduction in HCC recurrence. In conclusion, an AFP level > 1000 ng/mL may be a surrogate for vascular invasion and may be used to predict posttransplant HCC recurrence. Incorporating an AFP level > 1000 ng/mL as an exclusion criterion for LT within the Milan criteria may further improve posttransplant

  3. Management of Uncomplicated Acute Appendicitis as Day Case Surgery: Feasibility and a Critical Analysis of Exclusion Criteria and Treatment Failure.

    Science.gov (United States)

    Grelpois, Gérard; Sabbagh, Charles; Cosse, Cyril; Robert, Brice; Chapuis-Roux, Emilie; Ntouba, Alexandre; Lion, Thierry; Regimbeau, Jean-Marc

    2016-11-01

    Day case surgery (DCS) for uncomplicated acute appendicitis (NCAA) is evaluated. The objective of this prospective, single-center, descriptive, nonrandomized, intention-to-treat cohort study was to assess the feasibility of DCS for NCAA with a critical analysis of the reasons for exclusion and treatment failures and a focus on patients discharged to home and admitted for DCS on the following day. From April 2013 to December 2015, NCAA patients meeting the inclusion criteria were included in the study. The primary end point was the success rate for DCS (length of stay less than 12 hours) in the intention-to-treat population (all NCAA) and in the per-protocol population (no pre- or perioperative exclusion criteria). The secondary end points were morbidity, DCS quality criteria, predictive factors for successful DCS, patient satisfaction, quality of life, and reasons for pre- or perioperative exclusion. A subgroup of patients discharged to home the day before operation was also analyzed. A total of 240 patients were included. The success rate of DCS was 31.5% in the intention-to-treat population and 91.5% in the per-protocol population. The rates of unplanned consultations, hospitalization, and reoperation were 13%, 4%, and 1%, respectively. An analysis of the reasons for DCS exclusion showed that 73% could have been modified. For the 68 patients discharged to home on the day before operation, the DCS success rate was 91%. Day case surgery is feasible in NCAA. A critical analysis of the reasons for exclusion from DCS showed that it should be possible to dramatically increase the eligible population. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Combinations of Genetic Variants Occurring Exclusively in Patients

    Directory of Open Access Journals (Sweden)

    Erling Mellerup

    Full Text Available In studies of polygenic disorders, scanning the genetic variants can be used to identify variant combinations. Combinations that are exclusively found in patients can be separated from those combinations occurring in control persons. Statistical analyses can be performed to determine whether the combinations that occur exclusively among patients are significantly associated with the investigated disorder. This research strategy has been applied in materials from various polygenic disorders, identifying clusters of patient-specific genetic variant combinations that are significant associated with the investigated disorders. Combinations from these clusters are found in the genomes of up to 55% of investigated patients, and are not present in the genomes of any control persons. Keywords: Genetic variants, Polygenic disorder, Combinations of genetic variants, Patient-specific combinations

  5. Liver Transplantation: Evolving Patient Selection Criteria

    Directory of Open Access Journals (Sweden)

    Andy S Yu

    2001-01-01

    Full Text Available The widespread recognition of the success of liver transplantation as a treatment for most types of acute and chronic liver failure has led to increased referrals for transplantation in the setting of a relatively fixed supply of cadaver donor organs. These events have led to a marked lengthening of the waiting time for liver transplantation, resulting in increased deaths of those on the waiting list and sicker patients undergoing transplantation. Nearly 5000 liver transplantations were performed in the United States in 2000, while the waiting list grew to over 17,000 patients. The mounting disparity between the number of liver transplant candidates and the limited supply of donor organs has led to reassessment of the selection and listing criteria for liver transplantation, as well as revision of organ allocation and distribution policies for cadaver livers. The development of minimal listing criteria for patients with chronic liver disease based on a specific definition for decompensation of cirrhosis has facilitated the more uniform listing of patients at individual centres across the United States. The United Network for Organ Sharing, under pressure from transplant professionals, patient advocacy groups and the federal government, has continuously revised allocation and distribution policies based on the ethical principles of justice for the individual patient versus optimal utility of the limited organ supply available annually. Beginning in 2002, it is likely that the Model for End-stage Liver Disease (MELD score will be implemented to determine disease severity and direct donor organs to the sickest patients rather than to those with the longest waiting times.

  6. Surgery for nonobese type 2 diabetic patients: an interventional study with duodenal-jejunal exclusion.

    Science.gov (United States)

    Geloneze, Bruno; Geloneze, Sylka R; Fiori, Carla; Stabe, Christiane; Tambascia, Marcos A; Chaim, Elinton A; Astiarraga, Brenno D; Pareja, Jose Carlos

    2009-08-01

    A 24-week interventional prospective trial was performed to compare the benefits of open duodenal-jejunal exclusion surgery (GJB) with a matched control group on standard medical care. One-hundred eighty patients were screened for the surgical approach. Twelve patients accepted to be operated and presented the full eligibility criteria for surgery that includes overweight BMI (25-29.9 kg/m2), T2DM diagnosis for less than 15 years, insulin-treated patients, no history of major complications, preserved beta-cell function, and absence of autoimmunity. A matched control group (CG) of patients whom refused surgical treatment was placed to receive standard care. Patients had age of 50 (5) years, time of diagnosis 9 years (range, 3 to 15 years), time of insulin usage 6 months (range, 3 to 48 months), fasting glucose (FG), 9.8 (2.5) mg/dL, and glycated hemoglobin (A1C) 8.90 (2.12)%. At 24 weeks after surgery, patients experienced greater reductions on FG (14% vs. 7% on CG), A1C (from 8.78 to 7.84 in GJB-p<0.01 and 8.93 to 8.71 in CG; p<0.05 between groups) and reductions on average daily insulin requirement (93% vs. 29%, p<0.01). Ten patients stopped insulin usage in GJB but they remain taking oral medications. No differences were observed in both groups regarding BMI, body distribution and composition, blood pressure, and lipids. In conclusion, duodenal-jejunal exclusion was an effective treatment for nonobese T2DM subjects. GJB was superior to standard care in achieving better glycemic control along with reduction in insulin requirements.

  7. Ventilator-Associated Pneumonia in Trauma Patients: Different Criteria, Different Rates.

    Science.gov (United States)

    Leonard, Kenji L; Borst, Gregory M; Davies, Stephen W; Coogan, Michael; Waibel, Brett H; Poulin, Nathaniel R; Bard, Michael R; Goettler, Claudia E; Rinehart, Shane M; Toschlog, Eric A

    2016-06-01

    No consensus exists regarding the definition of ventilator-associated pneumonia (VAP). Even within a single institution, inconsistent diagnostic criteria result in conflicting rates of VAP. As a Level 1 trauma center participating in the Trauma Quality Improvement Project (TQIP) and the National Healthcare Safety Network (NHSN), our institution showed inconsistencies in VAP rates depending on which criteria was applied. The purpose of this study was to compare VAP definitions, defined by culture-based criteria, National Trauma Data Bank (NTDB) and NHSN, using incidence in trauma patients. A retrospective chart review of consecutive trauma patients who were diagnosed with VAP and met pre-determined inclusion and exclusion criteria admitted to our rural, 861-bed, Level 1 trauma and tertiary care center between January 2008 and December 2011 was performed. These patients were identified from the National Trauma Registry of the American College of Surgeons (NTRACS) database and an in-house infection control database. Ventilator-associated pneumonia diagnosis criteria defined by the U.S. Center for Disease Control and Prevention (used by the NHSN), the NTDB, and our institutional, culture-based criteria gold standard were compared among patients. Two hundred seventy-nine patients were diagnosed with VAP (25.4% met NHSN criteria, 88.2% met NTDB, and 76.3% met culture-based criteria). Only 58 (20.1%) patients met all three criteria. When NHSN criteria were compared with culture-based criteria, NHSN showed a high specificity (92.5%) and low sensitivity (28.2%). The positive predictive value (PPV) was 84.5%, but the negative predictive value (NPV) was 47.1%. The agreement between the NHSN and the culture-based criteria was poor (κ = 0.18). Conversely, the NTDB showed a lower specificity (57.8%), but greater sensitivity (86.4%) compared with culture-based criteria. The PPV and NPV were both 74% and the two criteria showed fair agreement (κ = 0.41). The lack of

  8. A Positive Diagnostic Strategy Is Noninferior to a Strategy of Exclusion for Patients With Irritable Bowel Syndrome

    DEFF Research Database (Denmark)

    Begtrup, Luise M; Engsbro, Anne Line; Kjeldsen, Jens

    2013-01-01

    . No cases of inflammatory bowel disease, colorectal cancer, or celiac disease were found. CONCLUSIONS: In diagnosing IBS in primary care, use of a positive diagnostic strategy is noninferior to using a strategy of exclusion with regard to the patients' HRQOL. Our findings support the current guideline......BACKGROUND & AIMS: Guidelines recommend a positive strategy based on symptom criteria to diagnose patients with irritable bowel syndrome (IBS). We conducted a randomized noninferiority trial to determine whether a positive diagnostic strategy is noninferior to a strategy of exclusion, with regard...... year between groups (on the basis of the Short Form 36 health survey, physical component summary, and noninferiority margin of 3 points). Secondary outcomes were change in gastrointestinal symptoms, satisfaction with management, and use of resources. Findings of diagnostic misclassification were...

  9. Development of statewide geriatric patients trauma triage criteria.

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    Werman, Howard A; Erskine, Timothy; Caterino, Jeffrey; Riebe, Jane F; Valasek, Tricia

    2011-06-01

    The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims. A literature search was conducted for all relevant literature to determine potential, geriatric-specific, field-destination criteria. Data from the Ohio Trauma Registry were used to compare elderly patients, defined as age >70 years, to all patients between the ages of 16 to 69 years with regards to mortality risk in the following areas: (1) Glasgow Coma Scale (GCS) score; (2) systolic blood pressure (SBP); (3) falls associated with head, chest, abdominal or spinal injury; (4) mechanism of injury; (5) involvement of more than one body system as defined in the Barell matrix; and (6) co-morbidities and motor vehicle collision with one or more long bone fracture. For GCS score and SBP, those cut-off points with equal or greater risk of mortality as compared to current values were chosen as proposed triage criteria. For other measures, any criterion demonstrating a statistically significant increase in mortality risk was included in the proposed criteria. The following criteria were identified as geriatric-specific criteria: (1) GCS score trauma; (2) SBP trauma. In addition, these data suggested that elderly patients with specific co-morbidities be given strong consideration for evaluation in a trauma center. The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the

  10. [Inappropriate prescription in older patients: the STOPP/START criteria].

    LENUS (Irish Health Repository)

    Delgado Silveira, Eva

    2009-09-01

    Older people are a heterogeneous group of patients, often with multiple comorbidities for which they are prescribed a large number of drugs, leading to an increased risk of adverse drug reactions (ADR) and drug interactions. This risk is compounded by physiological age-related changes in physiology, changes in drug pharmacokinetics and pharmacodynamics, as well as by disease-related, functional and social issues. Inappropriate prescription of drugs is common in the older individuals and contributes to the increased risk of ADR. Several tools have been developed to detect potentially inappropriate prescription, the most frequently used in Spain being Beers\\' criteria. However, the value of these criteria is limited, especially as they were developed in a different healthcare system. In this article, the Spanish version of a new tool to detect potentially inappropriate prescriptions-STOPP (Screening Tool of Older Person\\'s Prescriptions) and START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) criteria-is presented. The creation, development, reliability, and use of these criteria in routine practice is described and discussed. These criteria have shown better sensitivity than Beers\\' criteria in detecting prescription problems and have the added value of being able to detect not only inappropriate prescription of some drugs, but also the omission of well indicated drugs. The STOPP\\/START criteria could become a useful screening tool to improve prescription in older people.

  11. Exclusion of pneumothorax by radionuclide lung scan

    International Nuclear Information System (INIS)

    Weiss, P.E.

    1986-01-01

    A case is reported in which ventilation lung imaging was useful in excluding a large pneumothorax. This technique may be helpful in patients with emphysema in whom exclusion of pneumothorax by radiographic criteria might be difficult

  12. Exclusive and adjuvant radiotherapy in breast cancer patients with synchronous metastases

    International Nuclear Information System (INIS)

    Le Scodan, Romuald; Ali, David; Stevens, Denise

    2010-01-01

    Data from the Surveillance, Epidemiology, and End Results program and the European Concerted Action on survival and Care of Cancer Patients (EUROCARE) project indicate that about 6% of women newly diagnosed with breast cancer have stage IV disease, representing about 12 600 new cases per year in the United States in 2005. Historically, local therapy of the primary tumor in this setting has been aimed solely at symptom palliation. However, several studies suggest that surgical excision of the primary tumor can prolong these patients' survival. Exclusive locoregional radiotherapy is an alternative form of locoregional treatment in this setting and may represent an effective alternative to surgery in this setting. Here we discuss current issues regarding exclusive and adjuvant locoregional radiotherapy in breast cancer patients with synchronous metastases. Several studies suggest that surgery or exclusive irradiation of the primary tumor is associated with better survival in breast cancer patients with synchronous metastases and that exclusive locoregional radiotherapy may represent an effective alternative to surgery in this setting. Results of well-designed prospective studies are needed to re-evaluate treatment of the primary breast tumor in patients with metastases at diagnosis, and to identify those patients who are most likely to benefit

  13. Nutritional status and quality of life of cancer patients needing exclusive chemotherapy: a longitudinal study.

    Science.gov (United States)

    Salas, Sebastien; Mercier, Sophie; Moheng, Benjamin; Olivet, Sandrine; Garcia, Marie-Eve; Hamon, Sophie; Sibertin-Blanc, Camille; Duffaud, Florence; Auquier, Pascal; Baumstarck, Karine

    2017-04-27

    The aims of this study were to report nutritional status in a large panel of patients with cancer requiring exclusive chemotherapy and to study the influence of nutritional status on their quality of life (QoL). This work was a longitudinal cohort study performed at a French university teaching hospital. Eligible patients were individuals with a cancer needing treatment based on exclusive chemotherapy. Three work-ups were performed: i) before the administration of the first course of chemotherapy: T1, ii) before the administration of the second (for patients with 3 planned courses) or third (patients with 6 planned courses) course: T2, and iii) before the administration of the last planned course: T3. The following data were collected: general health (performance status) and nutritional status (weight, anorexia grading, albuminemia, pre-albuminemia, and C-reactive protein) and QoL. The nutritional status of patients with cancer was preserved. Functional impairment, the presence of anorexia, the palliative nature of the chemotherapy, and an elevated C-reactive protein dosage were independent predictive factors of a lower QoL among patients assessed at the end of chemotherapy. Although larger studies should corroborate these findings, clinicians may include this information in the management of patients with cancer requiring exclusive chemotherapy to identify the most vulnerable patients. Current controlled trials NCT01687335 (registration date: October 6, 2011).

  14. Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria

    Directory of Open Access Journals (Sweden)

    Bonet M

    2012-06-01

    Full Text Available Objective: The aims of this study were to identify potentially inappropriate prescribing using the Beers and STOPP criteria. The START criteria were applied to detect prescription omission in the geriatric population. We compared the utility of these criteria in institutionalised older people.Methods: Descriptive study reviewing the medication and clinical records of 81 residents (aged 65 years and more by pharmacists in a nursing home in the Lleida region (Spain.Results: The mean patients’ age was 84 (SD=8 years, with an average of 5 drugs per resident (total prescriptions: 416 medicines. The Beers criteria identified potentially inappropriate medication use in 25% of patients and 48% of patients used at least 1 inappropriate medication according to STOPP criteria. The most frequent potentially inappropriate medications for both criteria were long-acting benzodiazepines and NSAIDs. START detected 58 potential prescribing omissions in 44% of patients. Calcium-vitamin D supplementation in osteoporosis was the most frequent rule (15%, but omissions corresponding to the cardiovascular system implied 23% of patients.Conclusion: The STOPP-START criteria reveal that potentially inappropriate prescribing (PIP is a highly prevalent problem among Spanish nursing home residents, and a statistically significant positive correlation was found between the number of medicines prescribed and the number of PIP detected in this study. The STOPP criteria detect a larger number of PI medications in this geriatric population than the Beers criteria. The prescribing omissions detected by the START criteria are relevant and require intervention. Pharmacists’ review of medications may help identify potentially inappropriate prescribing and, through an interdisciplinary approach, working with physicians may improve prescribing practices among geriatric residents of nursing homes.

  15. MRI criteria for MS in patients with clinically isolated syndromes

    DEFF Research Database (Denmark)

    Montalban, X.; Tintore, M.; Swanton, J.

    2010-01-01

    neurologists and neuroradiologists. In some circumstances, several MRI examinations are needed to achieve an accurate and prompt diagnosis. This provides an incentive for continued efforts to refine the incorporation of MRI-derived information into the diagnostic workup of patients presenting with a clinically...... isolated syndrome. Within the European multicenter collaborative research network that studies MRI in MS (MAGNIMS), a workshop was held in London in November 2007 to review information that may simplify the existing MS diagnostic criteria, while maintaining a high specificity that is essential to minimize...... false positive diagnoses. New data that are now published were reviewed and discussed and together with a new proposal are integrated in this position paper. Neurology(R) 2010;74:427-434...

  16. Release criteria for patients having undergone radionuclide therapy and criteria for their crossing the state border of the Russian Federation

    International Nuclear Information System (INIS)

    Zvonova, I.; Balonov, M.; Golikov, V.

    2011-01-01

    By means of a conservative dosimetry model, the values of operational radiological criteria for patients released from hospital-residual activity in a body and dose rate near the patient's body-are substantiated based on the effective dose limit of 5 mSv for persons helping the patient or living with him and 1 mSv for other adults and children. Two sets of operative criteria for radionuclides 125 I, 131 I, 153 Sm and 188 Re used in Russia for radionuclide therapy were derived. Release criteria for 125 I well differ from such values in other countries because in this work absorption of 125 I low-energy photon radiation in the patient was taken into account. When a patient having undergone radionuclide therapy crosses the frontier of Russia, high-sensitivity devices for radiation control at the custom can detect the patient. A simplified radiological assessment of the patient was suggested aimed at provision of radiation safety for patient companions in transport. (authors)

  17. Comparison of DSM-IV and DSM-5 criteria for alcohol use disorders in VA primary care patients with frequent heavy drinking enrolled in a trial.

    Science.gov (United States)

    Takahashi, Traci; Lapham, Gwen; Chavez, Laura J; Lee, Amy K; Williams, Emily C; Richards, Julie E; Greenberg, Diane; Rubinsky, Anna; Berger, Douglas; Hawkins, Eric J; Merrill, Joseph O; Bradley, Katharine A

    2017-07-18

    Criteria for alcohol use disorders (AUD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) were intended to result in a similar prevalence of AUD as DSM-IV. We evaluated the prevalence of AUD using DSM-5 and DSM-IV criteria, and compared characteristics of patients who met criteria for: neither DSM-5 nor DSM-IV AUD, DSM-5 alone, DSM-IV alone, or both, among Veterans Administration (VA) outpatients in the Considering Healthier drinking Options In primary CarE (CHOICE) trial. VA primary care patients who reported frequent heavy drinking and enrolled in the CHOICE trial were interviewed at baseline using the DSM-IV Mini International Neuropsychiatric Interview for AUD, as well as questions about socio-demographics, mental health, alcohol craving, and substance use. We compared characteristics across 4 mutually exclusive groups based on DSM-5 and DSM-IV criteria. Of 304 participants, 13.8% met criteria for neither DSM-5 nor DSM-IV AUD; 12.8% met criteria for DSM-5 alone, and 73.0% met criteria for both DSM-IV and DSM-5. Only 1 patient (0.3%) met criteria for DSM-IV AUD alone. Patients meeting both DSM-5 and DSM-IV criteria had more negative drinking consequences, mental health symptoms and self-reported readiness to change compared with those meeting DSM-5 criteria alone or neither DSM-5 nor DSM-IV criteria. In this sample of primary care patients with frequent heavy drinking, DSM-5 identified 13% more patients with AUD than DSM-IV. This group had a lower mental health symptom burden and less self-reported readiness to change compared to those meeting criteria for both DSM-IV and DSM-5 AUD. Trial Registration ClinicalTrials.gov NCT01400581. 2011 February 17.

  18. Endovascular Exclusion of an Abdominal Aortic Aneurysm in Patients with Concomitant Abdominal Malignancy: Early Experience

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    Choi, You Ri; Chang, Nam Kyu [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Shin, Hyo Hyun; Oh, Hyun Jun; Kim, Jae Kyu; Choi, Soo Jin Na; Chung, Sang Young [Chonnam National University Hospital, Gwangju (Korea, Republic of); Yim, Nam Yeol [Armed Forces Yangju Hospital, Yangju (Korea, Republic of)

    2010-08-15

    To assess the outcomes of endovascular aortic aneurysm repair (EVAR) for the treatment of an abdominal aortic aneurysm in patients undergoing curative surgical treatment for concomitant abdominal malignancy. The study included 12 patients with abdominal neoplasia and an abdominal aortic aneurysm (AAA), which was treated by surgery and stent EVAR. The neoplasm consisted of the gastric, colorectal, pancreas, prostate, and gall bladder. The follow up period was 3-21 months (mean 11.8 months). All medical records and imaging analyses were reviewed by CTA and/or color Doppler US, retrospectively. Successful endoluminal repair was accomplished in all twelve patients. The mean interval time between EVAR and surgery was 58.6 days. Small amounts of type 2 endoleaks were detected in two patients (17%). One patient developed adult respiratory distress syndrome after Whipple's operation 20 days after surgery, which led to hopeless discharge. No procedure-related mortality, morbidity, or graft-related infection was noted. Exclusion of AAA in patients with accompanying malignancy show with a relatively low procedure morbidity and mortality. Hence, endoluminal AAA repair in patients with synchronous neoplasia may allow greater flexibility in the management of an offending malignancy

  19. Endovascular Exclusion of an Abdominal Aortic Aneurysm in Patients with Concomitant Abdominal Malignancy: Early Experience

    International Nuclear Information System (INIS)

    Choi, You Ri; Chang, Nam Kyu; Shin, Hyo Hyun; Oh, Hyun Jun; Kim, Jae Kyu; Choi, Soo Jin Na; Chung, Sang Young; Yim, Nam Yeol

    2010-01-01

    To assess the outcomes of endovascular aortic aneurysm repair (EVAR) for the treatment of an abdominal aortic aneurysm in patients undergoing curative surgical treatment for concomitant abdominal malignancy. The study included 12 patients with abdominal neoplasia and an abdominal aortic aneurysm (AAA), which was treated by surgery and stent EVAR. The neoplasm consisted of the gastric, colorectal, pancreas, prostate, and gall bladder. The follow up period was 3-21 months (mean 11.8 months). All medical records and imaging analyses were reviewed by CTA and/or color Doppler US, retrospectively. Successful endoluminal repair was accomplished in all twelve patients. The mean interval time between EVAR and surgery was 58.6 days. Small amounts of type 2 endoleaks were detected in two patients (17%). One patient developed adult respiratory distress syndrome after Whipple's operation 20 days after surgery, which led to hopeless discharge. No procedure-related mortality, morbidity, or graft-related infection was noted. Exclusion of AAA in patients with accompanying malignancy show with a relatively low procedure morbidity and mortality. Hence, endoluminal AAA repair in patients with synchronous neoplasia may allow greater flexibility in the management of an offending malignancy

  20. Development and Validation of Quality Criteria for Providing Patient- and Family-centered Injury Care.

    Science.gov (United States)

    Boyd, Jamie M; Burton, Rachael; Butler, Barb L; Dyer, Dianne; Evans, David C; Felteau, Melissa; Gruen, Russell L; Jaffe, Kenneth M; Kortbeek, John; Lang, Eddy; Lougheed, Val; Moore, Lynne; Narciso, Michelle; Oxland, Peter; Rivara, Frederick P; Roberts, Derek; Sarakbi, Diana; Vine, Karen; Stelfox, Henry T

    2017-08-01

    The aim of this study was to develop and evaluate the content validity of quality criteria for providing patient- and family-centered injury care. Quality criteria have been developed for clinical injury care, but not patient- and family-centered injury care. Using a modified Research AND Development Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Methodology, a panel of 16 patients, family members, injury and quality of care experts serially rated and revised criteria for patient- and family-centered injury care identified from patient and family focus groups. The criteria were then sent to 384 verified trauma centers in the United States, Canada, Australia, and New Zealand for evaluation. A total of 46 criteria were rated and revised by the panel over 4 rounds of review producing 14 criteria related to clinical care (n = 4; transitions of care, pain management, patient safety, provider competence), communication (n = 3; information for patients/families; communication of discharge plans to patients/families, communication between hospital and community providers), holistic care (n = 4; patient hygiene, kindness and respect, family access to patient, social and spiritual support) and end-of-life care (n = 3; decision making, end-of-life care, family follow-up). Medical directors, managers, or coordinators representing 254 trauma centers (66% response rate) rated 12 criteria to be important (95% of responses) for patient- and family-centered injury care. Fewer centers rated family access to the patient (80%) and family follow-up after patient death (65%) to be important criteria. Fourteen-candidate quality criteria for patient- and family-centered injury care were developed and shown to have content validity. These may be used to guide quality improvement practices.

  1. Amplifying Each Patient's Voice: A Systematic Review of Multi-criteria Decision Analyses Involving Patients.

    Science.gov (United States)

    Marsh, Kevin; Caro, J Jaime; Hamed, Alaa; Zaiser, Erica

    2017-04-01

    Qualitative methods tend to be used to incorporate patient preferences into healthcare decision making. However, for patient preferences to be given adequate consideration by decision makers they need to be quantified. Multi-criteria decision analysis (MCDA) is one way to quantify and capture the patient voice. The objective of this review was to report on existing MCDAs involving patients to support the future use of MCDA to capture the patient voice. MEDLINE and EMBASE were searched in June 2014 for English-language papers with no date restriction. The following search terms were used: 'multi-criteria decision*', 'multiple criteria decision*', 'MCDA', 'benefit risk assessment*', 'risk benefit assessment*', 'multicriteri* decision*', 'MCDM', 'multi-criteri* decision*'. Abstracts were included if they reported the application of MCDA to assess healthcare interventions where patients were the source of weights. Abstracts were excluded if they did not apply MCDA, such as discussions of how MCDA could be used; or did not evaluate healthcare interventions, such as MCDAs to assess the level of health need in a locality. Data were extracted on weighting method, variation in patient and expert preferences, and discussion on different weighting techniques. The review identified ten English-language studies that reported an MCDA to assess healthcare interventions and involved patients as a source of weights. These studies reported 12 applications of MCDA. Different methods of preference elicitation were employed: direct weighting in workshops; discrete choice experiment surveys; and the analytical hierarchy process using both workshops and surveys. There was significant heterogeneity in patient responses and differences between patients, who put greater weight on disease characteristics and treatment convenience, and experts, who put more weight on efficacy. The studies highlighted cognitive challenges associated with some weighting methods, though patients' views on their

  2. Degree of agreement among sepsis diagnosis criteria in adult emergency room patients with infection

    Science.gov (United States)

    Sinto, R.; Chandra, A. T.; Lie, K. C.; Suwarto, S.

    2018-03-01

    The study on the degree of agreement among three established sepsis diagnosis criteria become the necessity to investigate the best sepsis diagnosis criteria in Indonesia further. A cross-sectional study of adult Emergency Room patients hospitalized with a diagnosis of infection in CiptoMangunkusumo Hospital, Indonesia was conducted during March and April 2017. We recorded diagnosis, gender, age, comorbidities, infection source, and origin. Every subject was classified into sepsis and non-sepsis based on 1991, 2001 and sepsis-3 criteria. Raw % and Kappa agreement coefficients (κ) were calculated according to previously established formula to measure the degree of agreement among three diagnostic criteria. As many as 278 subjects were included in this study. The raw % agreement and κ between 1991 and 2001 criteria is 69.07% and 0.34 respectively. The raw % agreement and κ between 2001 and sepsis-3 criteria is 56.12% and 0.15 respectively. The raw % agreement and κ between 1991 and sepsis-3 criteria is 48.19% and -0.02. In conclusions, there is afair agreement between 1991 and 2001 criteria, poor agreement between 2001 and sepsis-3 criteria, and poor disagreement between 1991 and sepsis-3 criteria. This necessitates further Indonesian study of the best diagnosis criteria to diagnose an infected patient with sepsis.

  3. Offload zone patient selection criteria to reduce ambulance offload delay

    NARCIS (Netherlands)

    Laan, Corine Maartje; Vanberkel, Peter T.; Boucherie, Richardus J.; Carter, Alix J.E.

    2016-01-01

    Emergency department overcrowding is a widespread problem and often leads to ambulance offload delay. If no bed is available when a patient arrives, the patient has to wait with the ambulance crew. A recent Canadian innovation is the offload zone—an area where multiple patients can wait with a

  4. PATIENT-CENTERED DECISION MAKING: LESSONS FROM MULTI-CRITERIA DECISION ANALYSIS FOR QUANTIFYING PATIENT PREFERENCES.

    Science.gov (United States)

    Marsh, Kevin; Caro, J Jaime; Zaiser, Erica; Heywood, James; Hamed, Alaa

    2018-01-01

    Patient preferences should be a central consideration in healthcare decision making. However, stories of patients challenging regulatory and reimbursement decisions has led to questions on whether patient voices are being considered sufficiently during those decision making processes. This has led some to argue that it is necessary to quantify patient preferences before they can be adequately considered. This study considers the lessons from the use of multi-criteria decision analysis (MCDA) for efforts to quantify patient preferences. It defines MCDA and summarizes the benefits it can provide to decision makers, identifies examples of MCDAs that have involved patients, and summarizes good practice guidelines as they relate to quantifying patient preferences. The guidance developed to support the use of MCDA in healthcare provide some useful considerations for the quantification of patient preferences, namely that researchers should give appropriate consideration to: the heterogeneity of patient preferences, and its relevance to decision makers; the cognitive challenges posed by different elicitation methods; and validity of the results they produce. Furthermore, it is important to consider how the relevance of these considerations varies with the decision being supported. The MCDA literature holds important lessons for how patient preferences should be quantified to support healthcare decision making.

  5. Aluminum toxicity in dialysis patients: Radiographic findings and establishment of biopsy-sparing criteria

    International Nuclear Information System (INIS)

    Kriegshauser, J.S.; Swee, R.G.; McCarthy, J.T.; Hauser, M.F.

    1986-01-01

    Aluminum toxicity in dialysis patients currently requires bone biopsy for diagnosis. The authors retrospectively reviewed the findings in 63 dialysis patients who had undergone bone biopsies. In 30 patients biopsies were negative for aluminum toxicity and in 33 patients biopsies were positive. In 17 of the 30 biopsy-negative patients, absence of aluminum toxicity could be predicted by a high parathyroid hormone (iPTH) level (>200 μEq/ml) and fewer than three fractures, or by the presence of osteosclerosis on radiographs. No biopsy-positive patients met these criteria (P < .001). In 16 of 33 biopsy-positive patients aluminum toxicity could be predicted by a low iPTH level (<500 μEq/ml) and more than three fractures. No biopsy-negative patient met these criteria (P < .001). Thus, based on the criteria we have identified, 52.4% of the patients could have been spared biopsy

  6. Interior design criteria for successful hospital patient rooms

    OpenAIRE

    Bilir, Seda

    1997-01-01

    Ankara : The Department of Interior Architecture and Environmental Design and Institute of Fine Arts of Bilkent University, 1997. Thesis (Master's) -- Bilkent University, 1997. Includes bibliographical references leaves 94-99 In this study, the design requirements of hospital acute-care patient rooms, which support the recovery and well-being of the patients, are examined. Patients' psycho-spatial needs which may be complementary to the healing effects of the medical treatme...

  7. Constipation is more frequent than diarrhea in patients fed exclusively by enteral nutrition: results of an observational study.

    Science.gov (United States)

    Bittencourt, Amanda F; Martins, Juliana R; Logullo, Luciana; Shiroma, Glaucia; Horie, Lilian; Ortolani, Maria Claudia; Silva, Maria de Lourdes T; Waitzberg, Dan L

    2012-08-01

    Digestive complications in enteral nutrition (EN) can negatively affect the nutrition clinical outcome of hospitalized patients. Diarrhea and constipation are intestinal motility disorders associated with pharmacotherapy, hydration, nutrition status, and age. The aim of this study was to analyze the frequency of these intestinal motility disorders in patients receiving EN and assess risk factors associated with diarrhea and constipation in hospitalized patients receiving exclusive EN therapy in a general hospital. The authors performed a sequential and observational study of 110 hospitalized adult patients fed exclusively by EN through a feeding tube. Patients were categorized according to the type of intestinal transit disorder as follows: group D (diarrhea, 3 or more watery evacuations in 24 hours), group C (constipation, less than 1 evacuation during 3 days), and group N (absence of diarrhea or constipation). All prescription drugs were recorded, and patients were analyzed according to the type and amount of medication received. The authors also investigated the presence of fiber in the enteral formula. Patients classified in group C represented 70% of the study population; group D comprised 13%, and group N represented 17%. There was an association between group C and orotracheal intubation as the indication for EN (P constipation (logistic regression analysis: P Constipation is more frequent than diarrhea in patients fed exclusively by EN. Enteral diet with fiber may protect against medication-associated intestinal motility disorders. The addition of prokinetic drugs seems to be useful in preventing constipation.

  8. Seronegative neuromyelitis optica spectrum disorder patients diagnosed using new diagnostic criteria.

    Science.gov (United States)

    Uzawa, Akiyuki; Mori, Masahiro; Uchida, Tomohiko; Masuda, Hiroki; Ohtani, Ryohei; Kuwabara, Satoshi

    2016-09-01

    Recently, new diagnostic criteria for neuromyelitis optica spectrum disorders (NMOSD) were published. Our primary aim was to evaluate the usefulness of the new diagnostic criteria in anti-aquaporin 4 (AQP4) antibody-negative cases. Consecutive 471 patients whose anti-AQP4 antibody was measured at Chiba University were reviewed. Four anti-AQP4 antibody negative-patients, who fulfilled the new diagnostic criteria for NMOSD but not 2006 diagnostic criteria for neuromyelitis optica (NMO), were identified. They showed high cerebrospinal fluid interleukin-6 and glial fibrillary acidic protein levels, an absence of oligoclonal bands and/or cloud-like enhancement on magnetic resonance imaging, which are compatible findings for NMO. The new diagnostic criteria are clinically useful in seronegative NMOSD. © The Author(s), 2015.

  9. Metabolic syndrome criteria as predictors of insulin resistance, inflammation and mortality in chronic hemodialysis patients.

    Science.gov (United States)

    Vogt, Barbara Perez; Souza, Priscilla L; Minicucci, Marcos Ferreira; Martin, Luis Cuadrado; Barretti, Pasqual; Caramori, Jacqueline Teixeira

    2014-10-01

    Abstract Background: Chronic kidney disease (CKD) and metabolic syndrome are characterized by overlapping disorders, including glucose intolerance, hypertension, dyslipidemia, and, in some cases, obesity. However, there are no specific criteria for the diagnosis of metabolic syndrome in CKD. Metabolic syndrome can also be associated with increased risk of mortality. Some traditional risk factors may protect dialysis patients from mortality, known as "reverse epidemiology." Metabolic syndrome might undergo reverse epidemiology. The objectives were to detect differences in frequency and metabolic characteristics associated with three sets of diagnostic criteria for metabolic syndrome, to evaluate the accuracy of insulin resistance (IR) and inflammation to identify patients with metabolic syndrome, and to investigate the effects of metabolic syndrome by three sets of diagnostic criteria on mortality in chronic hemodialysis patients. An observational study was conducted. Diagnostic criteria for metabolic syndrome proposed by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF), and Harmonizing the Metabolic Syndrome (HMetS) statement were applied to 98 hemodialysis patients. The prevalence of metabolic syndrome was 51%, 66.3%, and 75.3% according to NCEP ATP III, IDF, and HMetS criteria, respectively. Diagnosis of metabolic syndrome by HMetS was simultaneously capable of revealing both inflammation and IR, whereas NCEP ATP III and IDF criteria were only able to identify IR. Mortality risk increased in the presence of metabolic syndrome regardless of the criteria used. The prevalence of metabolic syndrome in hemodialysis varies according to the diagnostic criteria used. IR and inflammation predict metabolic syndrome only when diagnosed by HMetS criteria. HMetS was the diagnostic criteria that can predict the highest risk of mortality.

  10. Home blood pressure monitoring and self-titration of antihypertensive medications: Proposed patient selection criteria.

    Science.gov (United States)

    Hill, James R

    2016-05-01

    Recent studies have demonstrated that home blood pressure monitoring (HBPM), coupled with self-titration of medications is a viable intervention to control hypertension. There are currently no established criteria to evaluate patients for inclusion in such a program. The purpose of this discussion is to propose criteria for determining if a patient is appropriate to participate in a program of HBPM and self-titration. Inclusion criteria for two self-titration trials were examined, and additional factors in clinical practice were identified and discussed. Additional selection criteria were proposed to support the decision to enroll a patient in an antihypertensive self-titration program. Inclusion criteria from self-titration trials provide a reasonable starting point for choosing appropriate patients in clinical practice, but additional research is necessary. Adaptation of these criteria and consideration of the identified factors can be used to develop decision support instruments. Such instruments should be evaluated for effectiveness and reliability prior to use in clinical practice. HBPM combined with self-titration is an effective patient-centered approach for hypertension management. Decision support instruments to determine appropriate patients are necessary for safe and effective use in clinical practice. ©2015 American Association of Nurse Practitioners.

  11. The effect of different criteria on the number of patients blind from open-angle glaucoma

    Directory of Open Access Journals (Sweden)

    Heijl Anders

    2011-11-01

    Full Text Available Abstract Background The prevalence of blindness and visual impairment from glaucoma is influenced by the criteria used to define these entities, which differ between countries and regions, as well as among published reports. The objective of the present study was to ascertain the extent to which different criteria of blindness and visual impairment influence estimates of the number of patients classified as blind or visually impaired by glaucoma in a clinic-based population. Methods We conducted a retrospective chart review of 914 patients with open-angle glaucoma to compare numbers of patients identified as visually impaired with and without considering visual field status. We also compared proportions classified using World Health Organisation (WHO and United States (US blindness criteria, and applying a new US Social Security Administration (SSA disability criterion: perimetric mean deviation (MD ≤ -22 dB. Results Forty patients (4.4% were bilaterally blind from glaucoma by the WHO criteria. Fifty-two (5.7% were blind by the the US criterion. Assessing only visual acuity, 14 (1.5% patients were blind by the WHO criteria and 24 (2.6% by the US definition. Eighty-five (9.3% met the US SSA disability criterion. Among those, 52 were impaired also by the WHO definition. No patients impaired according to the WHO criteria had MD values better than -22 dB. Conclusions Excluding visual field status will seriously underestimate the prevalence of glaucoma blindness. In our patient population, 30% more patients were classified as blind by the US than by the WHO definition. Also, 60% more were identified as visually impaired by the US SSA criterion than by the WHO criteria. Visual field assessment is vital to determine visual impairment caused by glaucoma.

  12. Trauma team activation criteria in managing trauma patients at an emergency room in Thailand.

    Science.gov (United States)

    Wuthisuthimethawee, P

    2017-02-01

    Trauma team activation (TTA) criteria were first implemented in the Emergency Department (ED) of Songklanagarind Hospital in 2009 to treat severe trauma patients. To determine the efficacy of the TTA criteria on the acute trauma care process in the ED and the 28-day mortality rate. A 1-year prospective cohort study was conducted at the ED. Trauma patients who were 18 years old and over who met the TTA criteria were enrolled. Demographic data, physiologic parameters, ED length of stay (EDLOS), and the injury severity score (ISS) were recorded. Multiple logistic regression was used to determine the factors affecting 28-day mortality. Institutional review board approval was obtained from the Prince of Songkla University. A total of 80 patients (74 male and 6 female) were eligible with a mean age of 34.3 years old. Shock, penetrating torso injury, and pulse rate >120 beats per minute were the three most common criteria for trauma team consultation. At the ED, 9 patients (11.3 %) were non-survivors, 30 patients (37.5 %) needed immediate operation, and 41 patients (51.2 %) were admitted. All of the arrest patients died (p team activation criteria improved acute trauma care in the ED which was demonstrated by the decreased EDLOS and mortality rate. A high ISS is the sole parameter predicting mortality.

  13. Validity and reliability problems with patient global as a component of the ACR/EULAR remission criteria as used in clinical practice.

    Science.gov (United States)

    Masri, Karim R; Shaver, Timothy S; Shahouri, Shadi H; Wang, Shirley; Anderson, James D; Busch, Ruth E; Michaud, Kaleb; Mikuls, Ted R; Caplan, Liron; Wolfe, Frederick

    2012-06-01

    To investigate what factors influence patient global health assessment (PtGlobal), and how those factors and the reliability of PtGlobal affect the rate, reliability, and validity of recently published American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria when used in clinical practice. We examined consecutive patients with RA in clinical practice and identified 77 who met ACR/EULAR joint criteria for remission (≤ 1 swollen joint and ≤ 1 tender joint). We evaluated factors associated with a PtGlobal > 1, because a PtGlobal ≤ 1 defined ACR/EULAR remission in this group of patients who had already met ACR/EULAR joint criteria. Of the 77 patients examined, only 17 (22.1%) had PtGlobal ≤ 1 and thus fully satisfied ACR/EULAR criteria. A large proportion of patients not in remission by ACR/EULAR criteria had high PtGlobal related to noninflammatory issues, including low back pain, fatigue, and functional limitations, and a number of patients clustered in the range of PtGlobal > 1 and ≤ 2. However, the minimal detectable difference for PtGlobal was 2.3. In addition, compared with a PtGlobal severity score, a PtGlobal activity score was 3.3% less likely to be abnormal (> 1). Noninflammatory factors contribute to the level of PtGlobal and result in the exclusion of many patients who would otherwise be in "true" remission according to the ACR/EULAR definition. Reliability problems associated with PtGlobal can also result in misclassification, and may explain the observation of low longterm remission rates in RA. As currently constituted, the use of the ACR/EULAR remission criteria in clinical practice appears to be problematic.

  14. Comparison between Exclusive and Selective Drug-Eluting Stent Strategies in Treating Patients with Multivessel Coronary Artery Disease.

    Science.gov (United States)

    Tung, Ying-Chang; Hsiao, Ping-Gune; Hsu, Lung-An; Kuo, Chi-Tai; Chang, Chi-Jen

    2014-05-01

    The expanded usage of drug-eluting stents (DES) in treating patients with multivessel coronary artery disease (CAD) may sometimes be limited in real-world practice due to cost concerns. We compared the clinical outcomes of exclusive and selective DES use in treating patients with multivessel CAD. From November 2004 to December 2011, 110 patients with multivessel CAD who received four or more stents were enrolled into this study, and divided into two groups according to the DES strategy employed: exclusive DES (n = 52), or selective DES (n = 58). In the selective DES group, DES was reserved for complex lesions only, such that the incidence and predictors of clinical events were assessed. At a mean follow-up of 41.4 ± 26.5 months, there were no significant differences between the two strategies in terms of baseline characteristics, all-cause mortality (exclusive vs. selective: 1.9% vs. 6.9%, p = 0.21), cardiac death (1.9% vs. 1.7%, p = 0.94) and nonfatal myocardial infarction (3.8% vs. 5.2%, p = 0.74). Despite the presence of more ostial lesions in the exclusive DES group, there was a trend such that major adverse cardiac events (MACE) and target lesion revascularization (TLR) rates were higher in the selective DES group (MACE: 17.3% vs. 31%, p = 0.16; TLR: 11.5% vs. 24.1%, p = 0.08). The higher MACE rate in the selective DES group was mainly driven by a higher target vessel revascularization (TVR) rate (15.4% vs. 29.3%, p = 0.08). In the exclusive DES group, SYNTAX score was an independent predictor of MACE [Haxard ratio (HR): 1.09, 95% confidence internal (CI): 1.02-1.16, p = 0.01] and TVR (HR 1.08, 95% CI 1.01-1.15, p = 0.04). Compared to the exclusive DES strategy, the selective DES strategy with reservation of DES for complex lesions is associated with numerically higher, but not statistically significant, rates of MACE and all-cause mortality in this small group of patients with multivessel CAD receiving four or more stents. Bare metal stent; Drug

  15. Exclusive curietherapy by permanent iodine-125 implants: selection of patients and results after eight years; Curietherapie exclusive par implants permanents d'iode-125: selection des patients et resultats a huit ans

    Energy Technology Data Exchange (ETDEWEB)

    Boutenbat, G.; Peiffert, D.; Bernier, V.; Moreau, J.L.; Boudran, G.; Noel, A.; Marchesi, V.; Huget, S. [Centre Alexis Vautrin, 54 - Vandoeuvre-Les-Nancy (France); Moreau, J.L. [Cabinet prive d' urologie, 54 - Nancy (France); Boudran, G. [Centre Hospitalier Universitaire de Brabois, 54 - Vandoeuvre-Les-Nancy (France)

    2010-10-15

    The authors report a retrospective study which assesses the results obtained over eight years and the toxicity of an exclusive curietherapy by permanent iodine-125 implants performed at the Nancy centre of struggle against cancer. More than five hundred patients have been treated between December 1999 and December 2007, a first group comprising patients suffering from a low risk cancer and a second group suffering from a medium risk cancer. The authors discuss the survival rates, the existence of side effects, and rectal toxicity results. Short communication

  16. Applicability of the 2001 revised diagnostic criteria in Brazilian Vogt-Koyanagi-Harada disease patients.

    Science.gov (United States)

    Cardoso, Isabel Habeyche; Zajdenweber, Moysés Eduardo; Muccioli, Cristina; Fimamor, Luciana Peixoto; Belfort, Rubens

    2008-01-01

    To determine the applicability of the international revised diagnostic criteria for Vogt-Koyanagi-Harada disease. Retrospective study. Medical charts of 140 patients with the diagnosis of Vogt-Koyanagi-Harada disease, from the Uveitis Sector of the Federal University of Sao Paulo (UNIFESP), were revised and classified following the revised diagnostic criteria. Of the 140 patients, 12.85% fulfilled the criteria for complete disease, 29.28% incomplete disease, 28.57% "probable" Vogt-Koyanagi-Harada disease and 28.27% were considered not Vogt-Koyanagi-Harada disease. The authors consider that the international revised diagnostic criteria have good applicability and are very useful to help in the diagnosis of Vogt-Koyanagi-Harada disease.

  17. 76 FR 28308 - Compliance Policy Guide: Surgeons' Gloves and Patient Examination Gloves; Defects-Criteria for...

    Science.gov (United States)

    2011-05-17

    .... FDA-2011-D-0258] Compliance Policy Guide: Surgeons' Gloves and Patient Examination Gloves; Defects... Compliance Policy Guide Sec. 335.700, Surgeons' Gloves and Patient Examination Gloves; Defects--Criteria for... FDA staff on the submission of seizure recommendations for medical gloves that exceed the defect...

  18. Predictive validity of proposed remission criteria in first-episode schizophrenic patients responding to antipsychotics

    NARCIS (Netherlands)

    Wunderink, Lex; Nienhuis, Fokko J.; Sytema, Sjoerd; Wiersma, Durk

    The objective of this study was to examine the predictive validity of the remission criteria proposed by Andreasen et all in first-episode patients responding to antipsychotics. Antipsychotic responsive patients with first-episode schizophrenia showing symptom remission (n = 60) were compared with

  19. Medicatiescreening met Beers-criteria en STOPP/START-criteria bij de ouedere patient: associatie tussen potentieel ongewenst geneesmiddelengebruik en geneesmiddelgerelateerde ziekenhuisopnamen

    NARCIS (Netherlands)

    Stelt, CAK; Vermeulen Windsant - van der Tweel, AMA; Egberts, ACG; Van Den Bemt, Patricia M L A; Leendertse, AJ; Hermens, W.Th.; van Marum, R.J.; Derijks, H.J.

    2015-01-01

    Medication screening using Beers and stopp/start criteria for elderly patients: association between potentially inappropriate medication and medication-related hospital admissions OBJECTIVE To assess the risk of medication-related hospital admissions associated with inappropriate medication use

  20. Sorafenib for hepatocellular carcinoma patients beyond Milan criteria after orthotopic liver transplantation: a case control study

    Directory of Open Access Journals (Sweden)

    Teng Chieh-Lin

    2012-02-01

    Full Text Available Abstract Background Orthotopic liver transplantation (OLT is one of the most effective treatments for patients with hepatocellular carcinoma (HCC within the Milan criteria. However, for patients beyond these criteria, the recurrence rate is higher and the prognosis is worse. Sorafenib is the only drug showing survival benefits in advanced HCC patients; however, its role in patients beyond the Milan criteria after OLT remains unclear and requires further investigation. Methods As a case-control study, we retrospectively analyzed 17 Chinese patients beyond Milan criteria undergoing OLT for HCC. These patients were stratified into adjuvant (n = 5, palliative (n = 6, and control groups (n = 6. Results Nine of 11 patients who received sorafenib after OLT needed dose reduction due to more than grade 2 side effects. The disease-free survival rates for patients with or without adjuvant sorafenib were 100% versus 37.5% (p = 0.034 at 6 months, 66.7% versus 9.4% (p = 0.026 at 12 months, and 66.7% versus 0.0% (p = 0.011 at 18 months, respectively. The overall survival rates for patients in palliative and control groups were 66.7% versus 40.0% (p = 0.248 at 6 months, 66.7% versus 40.0% (p = 0.248 at 12 months, and 50.0% versus 20.0% (p = 0.17 at 18 months, respectively. Patients in the adjuvant group had better overall survival rates than those in the palliative and control groups (p = 0.031 at 24-month follow-up. Conclusions Adjuvant sorafenib could possibly extend both disease-free and overall survival for HCC patients beyond Milan criteria after OLT.

  1. Accuracy of Methotrexate Use in Rheumatoid Arthritis Patients in Emanuel Klampok Hospital based on Explicit Criteria

    Directory of Open Access Journals (Sweden)

    Rizki Puspitasari

    2014-09-01

    Full Text Available Methotrexate (MTX is the first line therapy for rheumatoid arthritis (RA as an antiinflammatory and immunosuppressant agent. The purpose of this study was to evaluate the use of MTX in patients with rheumatoid arthritis at Emanuel Klampok Hospital based on criteria, including the indication, process indicators, complication, and outcome indicators. The medical record from 13 inpatients and 27 outpatients who used MTX were compared with the criteria. The results of this study demonstrated that all of the patients had appropriately indications to use MTX. Patients with risk factors that lead to GI disorders, hepatotoxicity, and bone marrow toxicity were 35 patients, 19 patients, and 15 patients respectively. There were 32 patients used MTX with the correct dosage, meanwhile incorrect dosage was showed in 3 patients with ClCr 61–80 mL/minute, 2 patients with ClCr 51–60 mL/minute, 1 patient with ClCr 10–50 mL/minute, and 2 patients with SGPT >3 normal value. The interaction with NSAID was happened in 35 patients and the interaction with hepatotoxicity agents in 19 patients. Complication occurred in 7 patients with effects that occur were GI disorders and 1 patient with chirrosis. There were 10 patients with clinical complaints reduced and 2 patients with the better condition. Indication of use MTX had appropriately, but process indicators, complication, and outcome indicators still not appropriate.

  2. Regulatory analysis on criteria for the release of patients administered radioactive material

    International Nuclear Information System (INIS)

    Schneider, S.; McGuire, S.A.

    1994-05-01

    The Nuclear Regulatory Commission (NRC) has received two petitions to amend its regulations in 10 CFR Parts 20 and 35 as they apply to doses received by members of the public exposed to patients released from a hospital after they have been administered radioactive material. While the two petitions are not identical they both request that the NRC establish a dose limit of 5 millisieverts (0.5 rem) per year for individuals exposed to patients who have been administered radioactive materials. This Regulatory Analysis evaluates three alternatives. Alternative 1 is for the NRC to amend its patient release criteria in 10 CFR 35.75 to use the more stringent dose limit of 1 millisievert per year in 10 CFR 20.1301(a) for its patient release criteria. Alternative 2 is for the NRC to continue using the existing patient release criteria in 10 CFR 35.75 of 1,110 megabecquerels of activity or a dose rate at one meter from the patient of 0.05 millisievert per hour. Alternative 3 is for the NRC to amend the patient release criteria in 10 CFR 35.75 to specify a dose limit of 5 millisieverts for patient release. The evaluation indicates that Alternative 1 would cause a prohibitively large increase in the national health care cost from retaining patients in a hospital longer and would cause significant personal and psychological costs to patients and their families. The choice of Alternatives 2 or 3 would affect only thyroid cancer patients treated with iodine-131. For those patients, Alternative 3 would result in less hospitalization than Alternative 2. Alternative 3 has a potential decrease in national health care cost of $30,000,000 per year but would increase the potential collective dose from released therapy patients by about 2,700 person-rem per year, mainly to family members

  3. Regulatory analysis on criteria for the release of patients administered radioactive material

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, S.; McGuire, S.A. [Nuclear Regulatory Commission, Washington, DC (United States). Div. of Regulatory Applications; Behling, U.H.; Behling, K.; Goldin, D. [Cohen (S.) and Associates, Inc., McLean, VA (United States)

    1994-05-01

    The Nuclear Regulatory Commission (NRC) has received two petitions to amend its regulations in 10 CFR Parts 20 and 35 as they apply to doses received by members of the public exposed to patients released from a hospital after they have been administered radioactive material. While the two petitions are not identical they both request that the NRC establish a dose limit of 5 millisieverts (0.5 rem) per year for individuals exposed to patients who have been administered radioactive materials. This Regulatory Analysis evaluates three alternatives. Alternative 1 is for the NRC to amend its patient release criteria in 10 CFR 35.75 to use the more stringent dose limit of 1 millisievert per year in 10 CFR 20.1301(a) for its patient release criteria. Alternative 2 is for the NRC to continue using the existing patient release criteria in 10 CFR 35.75 of 1,110 megabecquerels of activity or a dose rate at one meter from the patient of 0.05 millisievert per hour. Alternative 3 is for the NRC to amend the patient release criteria in 10 CFR 35.75 to specify a dose limit of 5 millisieverts for patient release. The evaluation indicates that Alternative 1 would cause a prohibitively large increase in the national health care cost from retaining patients in a hospital longer and would cause significant personal and psychological costs to patients and their families. The choice of Alternatives 2 or 3 would affect only thyroid cancer patients treated with iodine-131. For those patients, Alternative 3 would result in less hospitalization than Alternative 2. Alternative 3 has a potential decrease in national health care cost of $30,000,000 per year but would increase the potential collective dose from released therapy patients by about 2,700 person-rem per year, mainly to family members.

  4. EVALUATION OF ULTRASOUND REMISSION CRITERIA IN PATIENTS WITH RHEUMATOID ARTHRITIS DURING TOCILIZUMAB THERAPY

    OpenAIRE

    Rita Aleksandrovna Osipyants; D E Karateev; E Yu Panasyuk; G V Lukina; A V Smirnov; S I Glukhova; E N Aleksandrova; A V Volkov; E L Nasonov

    2013-01-01

    Objective: to study the association of ultrasound (US) remission criteria with the clinical and laboratory indicators of inflammatory activity, functional status, and X-ray changes in patients with rheumatoid arthritis (RA) during tocilizumab (TCZ) therapy.Subjects and methods. The trial included 36 patients with RA (meeting the 1987 American College of Rheumatology (ACR) criteria) who had received TCZ for 6 months. The authors made a clinical and laboratory assessment of RA activity (DAS28-C...

  5. D-dimer testing for safe exclusion and risk stratification in patients with acute pulmonary embolism in primary care

    Directory of Open Access Journals (Sweden)

    Zhou Yin

    2015-01-01

    Full Text Available Background: Safe exclusion and risk stratification are currently recommended for the initial management of patients with acute pulmonary embolism (APE. The aim of this study was to assess the safe exclusion and risk stratification value of D-dimer (DD for APE when tested at the beginning of admission. Materials and Methods: All consecutive Chinese APE patients and controls were recruited from January 2010 to December 2012. All measurements of serum indexes were made in duplicate and blinded to the patients′ status. All the 40 patients with the first episode of APE were confirmed by multi-detector computed tomographic pulmonary angiography. The plasma prothrombin time (PT, activated partial thromboplastin time, thrombin time, fibrinogen, and DD levels were measured within 24 h of admission. We used the Mann-Whitney U-test to determine the differences between groups and drew receiver operator characteristic curve to evaluate the indexes′ value in the APE screening. Results: The PT and DD in the APE group were significantly higher than those in the disease control group (P 1820 μg/L as cut-off value, the sensitivity, specificity, positive and negative predictive value was 82.5%, 75.2%, 56.9%, and 91.6%, respectively. Conclusion: The patients with APE showed significant higher DD levels compared with disease controls, suggesting a negative qualitative DD test result can safely and efficiently exclude APE in primary care.

  6. Racial and ethnic disparities in meeting MTM eligibility criteria among patients with asthma.

    Science.gov (United States)

    Lu, Degan; Qiao, Yanru; Johnson, Karen C; Wang, Junling

    2017-06-01

    Asthma is one of the most frequently targeted chronic diseases in the medication therapy management (MTM) programs of the Medicare prescription drug (Part D) benefits. Although racial and ethnic disparities in meeting eligibility criteria for MTM services have been reported, little is known about whether there would be similar disparities among adults with asthma in the United States. Adult patients with asthma (age ≥ 18) from Medical Expenditure Panel Survey (2011-2012) were analyzed. Bivariate analyses were conducted to compare the proportions of patients who would meet Medicare MTM eligibility criteria between non-Hispanic Blacks (Blacks), Hispanics and non-Hispanic Whites (Whites). Survey-weighted logistic regression was performed to adjust for patient characteristics. Main and sensitivity analyses were conducted to cover the entire range of the eligibility thresholds used by Part D plans in 2011-2012. The sample included 4,455 patients with asthma, including 2,294 Whites, 1,218 Blacks, and 943 Hispanics. Blacks and Hispanics had lower proportions of meeting MTM eligibility criteria than did Whites (P asthma. Future studies should examine the implications of such disparities on health outcomes of patients with asthma and explore alternative MTM eligibility criteria.

  7. Analysis of patterns of three-phase bone scintigraphy for patients with complex regional pain syndrome diagnosed using the proposed research criteria (the 'Budapest Criteria').

    Science.gov (United States)

    Moon, J Y; Park, S Y; Kim, Y C; Lee, S C; Nahm, F S; Kim, J H; Kim, H; Oh, S W

    2012-04-01

    Three-phase bone scintigraphy (TPBS) is an established objective diagnostic method for complex regional pain syndrome (CRPS), but its validity remains controversial. The aims of this study were: (i) to re-evaluate the diagnostic performance of TPBS, and (ii) to suggest new TPBS criteria based on the proposed research criteria for CPRS in Budapest (the 2003 Budapest research criteria). The medical records of 228 consecutive patients, evaluated using the Budapest research criteria, were retrospectively analysed. Of these, 116 patients were included in the present study, and 69 of 116 were diagnosed to have CRPS based on these criteria. The diagnostic performance of TPBS was assessed by determining its sensitivity, specificity, and positive and negative likelihood ratios, and new criteria for TPBS were identified by pattern analysis using the Budapest research criteria. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of TPBS for the diagnosis of CRPS according to the Budapest research criteria were 40.0, 76.5, 1.73, and 0.78, respectively. Furthermore, D-D-D, D-D-S, and D-D-I patterns [i.e. according to decreased (D), symmetrical (S), or increased (I) tracer uptake during Phases I, II, and III] of TPBS were found to be positively predictive for CRPS. The diagnostic value of a positive TPBS for CRPS is low from the view point of the Budapest research criteria. Our findings suggest that a diagnosis of CRPS using the Budapest research criteria should be considered when decreased patterns of TPBS are observed during Phases I and II.

  8. Accuracy of Carotid Duplex Criteria in Diagnosis of Significant Carotid Stenosis in Asian Patients.

    Science.gov (United States)

    Dharmasaroja, Pornpatr A; Uransilp, Nattaphol; Watcharakorn, Arvemas; Piyabhan, Pritsana

    2018-03-01

    Extracranial carotid stenosis can be diagnosed by velocity criteria of carotid duplex. Whether they are accurately applied to define severity of internal carotid artery (ICA) stenosis in Asian patients needs to be proved. The purpose of this study was to evaluate the accuracy of 2 carotid duplex velocity criteria in defining significant carotid stenosis. Carotid duplex studies and magnetic resonance angiography were reviewed. Criteria 1 was recommended by the Society of Radiologists in Ultrasound; moderate stenosis (50%-69%): peak systolic velocity (PSV) 125-230 cm/s, diastolic velocity (DV) 40-100 cm/s; severe stenosis (>70%): PSV greater than 230 cm/s, DV greater than 100 cm/s. Criteria 2 used PSV greater than 140 cm/s, DV less than 110 cm/s to define moderate stenosis (50%-75%) and PSV greater than 140 cm/s, DV greater than 110 cm/s for severe stenosis (76%-95%). A total of 854 ICA segments were reviewed. There was moderate stenosis in 72 ICAs, severe stenosis in 50 ICAs, and occlusion in 78 ICAs. Criteria 2 had slightly lower sensitivity, whereas higher specificity and accuracy than criteria 1 were observed in detecting moderate stenosis (criteria 1: sensitivity 95%, specificity 83%, accuracy 84%; criteria 2: sensitivity 92%, specificity 92%, and accuracy 92%). However, in detection of severe ICA stenosis, no significant difference in sensitivity, specificity, and accuracy was found (criteria 1: sensitivity 82%, specificity 99.57%, accuracy 98%; criteria 2: sensitivity 86%, specificity 99.68%, and accuracy 99%). In the subgroup of moderate stenosis, the criteria using ICA PSV greater than 140 cm/s had higher specificity and accuracy than the criteria using ICA PSV 125-230 cm/s. However, there was no significant difference in detection of severe stenosis or occlusion of ICA. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Temporal stability of diagnostic criteria for antisocial personality disorder in male alcohol dependent patients

    NARCIS (Netherlands)

    Verheul, R.; van den Brink, W.; Koeter, M. W.

    1998-01-01

    We evaluated the temporal stability of diagnostic criteria for antisocial personality disorder in 432 male alcohol dependent patients. Indicators for temporal stability were criterion continuation (i.e., the proportion of current or recent diagnoses among those with a lifetime diagnosis) and

  10. Exclusion of Patients with a Severe T-Cell Defect Improves the Definition of Common Variable Immunodeficiency.

    Science.gov (United States)

    Bertinchamp, Rémi; Gérard, Laurence; Boutboul, David; Malphettes, Marion; Fieschi, Claire; Oksenhendler, Eric

    In 2014, the European Society for Immune Deficiencies (ESID) revised the common variable immunodeficiency (CVID) diagnosis criteria by incorporating new clinical and biological markers. The new definition appeared more restrictive but had not yet been evaluated in a large cohort of patients. The objective of this study was to evaluate the impact of this new definition in a large cohort of patients with primary hypogammaglobulinemia. Evaluation of 3 different CVID definitions (ESID/Pan-American Group for Immunodeficiency [PAGID] 1999, ESID 2014, DEFI 2015) in 521 patients included in the French DEFI study with a diagnosis of primary hypogammaglobulinemia. Using the ESID/PAGID 1999 definition, 351 patients were classified as CVID. The new ESID 2014 definition excluded 62 (18%) patients. Most of them (n = 56; 90%) had a less severe disease, whereas 6 (10%) presented with a severe disease with major T-cell defect. We propose different criteria (occurrence of opportunistic infection or very low naive CD4+ T-cell count) to define this population with severe T-cell defect. Sixty-two patients fulfilled these criteria, represented 20% of the initial CVID population but accounted for 77% of the deaths, with a 5-year overall survival of 67.6% (95% confidence interval, 51.0-79.6), and were considered as late onset combined immunodeficiency (LOCID). The new ESID definition for CVID still fails to exclude a large number of patients with severe T-cell defect. We propose a new definition (DEFI 2015) that excluded more patients with a T-cell defect and consider these patients as LOCID. This population has a poor outcome and should be considered as a distinct group requiring specific care. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  11. ASSESSMENT OF THE SENSITIVITY OF NEW CRITERIA FOR SYSTEMIC SCLEROSIS IN RUSSIAN PATIENT POPULATION

    Directory of Open Access Journals (Sweden)

    O. A. Koneva

    2015-01-01

    Full Text Available Systemic sclerosis (SS is a progressive connective tissue disease, the prognosis of which largely depends on the time of adequate therapy initiation. Low sensitivity of the 1980 American College of Rheumatology (ACR SS classification criteria for identifying patients with early stage of the disease, and with its limited form in particular, has necessitated revision of existing SS diagnostic standards and elaboration of more sensitive criteria that allow to establish the diagnosis when the first sign of the disease appear.Objective: to compare the sensitivity of the novel SS criteria of ACR and European League against Rheumatism (ACR/EULAR 2013 and the 1980 ACR criteria in different stages of the disease.Subjects and methods. The investigation enrolled 302 patients who had been diagnosed by experts as having SS and followed up at the V.A. Nasonova Research Institute of Rheumatology in 2007–2013. The patients’ mean age was 49±13 years (18 to 80 years; male to female ratio – 1:9 (31 and 271, that of patients with diffuse and limited SS – 1:2 (105 and 197; mean duration of the disease from the first non-Raynaud’s syndrome was 8.2±7.0 years (6 months to 36 years. Physical examination, nailfold capillaroscopy, chest radiography or computed tomography, echocardiography for the determination of pulmonary artery systolic pressure and SS-specific antibodies evaluation were performed.Results. 273 (90% patients fulfilled the novel ACR/EULAR 2013 SS criteria. 76 (25% patients had skin thickening above the metacarpophalangeal (MPC joints in both hands; 263 (87% – finger skin thickening [70 (23% – finger swelling, 192 (64% – thickening of all fingers distal to the MPC joints], 141 (47% – digital ischemia [79 (26% – digital pitting scars, 20 (7% – digital ulcers, 42 (14% – digital pitting scars and ulcers], 134 (44% – telangiectasias, 276 (91% – capillaroscopic changes, 225 (78% – pulmonary hypertension (PH or

  12. Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients

    Directory of Open Access Journals (Sweden)

    John Tran

    2016-05-01

    Full Text Available Introduction: The National Emergency X-radiography Utilization Study (NEXUS criteria are used extensively in emergency departments to rule out C-spine injuries (CSI in the general population. Although the NEXUS validation set included 2,943 elderly patients, multiple case reports and the Canadian C-Spine Rules question the validity of applying NEXUS to geriatric populations. The objective of this study was to validate a modified NEXUS criteria in a low-risk elderly fall population with two changes: a modified definition for distracting injury and the definition of normal mentation. Methods: This is a prospective, observational cohort study of geriatric fall patients who presented to a Level I trauma center and were not triaged to the trauma bay. Providers enrolled non-intoxicated patients at baseline mental status with no lateralizing neurologic deficits. They recorded midline neck tenderness, signs of trauma, and presence of other distracting injury. Results: We enrolled 800 patients. One patient fall event was excluded due to duplicate enrollment, and four were lost to follow up, leaving 795 for analysis. Average age was 83.6 (range 65-101. The numbers in parenthesis after the negative predictive value represent confidence interval. There were 11 (1.4% cervical spine injuries. One hundred seventeen patients had midline tenderness and seven of these had CSI; 366 patients had signs of trauma to the face/neck, and 10 of these patients had CSI. Using signs of trauma to the head/neck as the only distracting injury and baseline mental status as normal alertness, the modified NEXUS criteria was 100% sensitive (CI [67.9-100] with a negative predictive value of 100 (98.7-100. Conclusion: Our study suggests that a modified NEXUS criteria can be safely applied to low-risk elderly falls.

  13. Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients.

    Science.gov (United States)

    Tran, John; Jeanmonod, Donald; Agresti, Darin; Hamden, Khalief; Jeanmonod, Rebecca K

    2016-05-01

    The National Emergency X-radiography Utilization Study (NEXUS) criteria are used extensively in emergency departments to rule out C-spine injuries (CSI) in the general population. Although the NEXUS validation set included 2,943 elderly patients, multiple case reports and the Canadian C-Spine Rules question the validity of applying NEXUS to geriatric populations. The objective of this study was to validate a modified NEXUS criteria in a low-risk elderly fall population with two changes: a modified definition for distracting injury and the definition of normal mentation. This is a prospective, observational cohort study of geriatric fall patients who presented to a Level I trauma center and were not triaged to the trauma bay. Providers enrolled non-intoxicated patients at baseline mental status with no lateralizing neurologic deficits. They recorded midline neck tenderness, signs of trauma, and presence of other distracting injury. We enrolled 800 patients. One patient fall event was excluded due to duplicate enrollment, and four were lost to follow up, leaving 795 for analysis. Average age was 83.6 (range 65-101). The numbers in parenthesis after the negative predictive value represent confidence interval. There were 11 (1.4%) cervical spine injuries. One hundred seventeen patients had midline tenderness and seven of these had CSI; 366 patients had signs of trauma to the face/neck, and 10 of these patients had CSI. Using signs of trauma to the head/neck as the only distracting injury and baseline mental status as normal alertness, the modified NEXUS criteria was 100% sensitive (CI [67.9-100]) with a negative predictive value of 100 (98.7-100). Our study suggests that a modified NEXUS criteria can be safely applied to low-risk elderly falls.

  14. Analysis of audiometric relapse-free survival in patients with immune-mediated hearing loss exclusively treated with corticosteroids.

    Science.gov (United States)

    Mata-Castro, Nieves; García-Chilleron, Raimon; Gavilanes-Plasencia, Javier; Ramírez-Camacho, Rafael; García-Fernández, Alfredo; García-Berrocal, José Ramón

    2017-10-12

    To describe the results in terms of audiometric relapse-free survival and relapse rate in immunomediated hearing loss patients treated exclusively with corticosteroids. Retrospective study of patients with audiometric relapses, monitored from 1995 to 2014, in two centres of the Community of Madrid. We evaluated 31 patients with a mean age of 48.52 years (14.67 SD), of which 61.3% were women. Most hearing loss was fluctuating (48.4%). Only 16.1% of patients had systemic autoimmune disease. There is a moderate positive correlation between the sex variable and the systemic involvement variable (Spearman's correlation coefficient=0.356): specifically, between being female and systemic disease. The relative incidence rate of relapse in the first year was 2.01 relapses/year with a 95% CI (1.32 to 2.92). The mean survival time of the event (audiometric relapse) was 5.25 months (SD 0.756). With multivariate analysis, the only variable that achieved statistical significance was age, with a hazard ratio of 1.032 (95% CI; 1.001-1.063, P=.043). Immune-mediated disease of the inner ear is a chronic disease with relapses. Half of the patients with immunomediated hearing loss treated exclusively with corticosteroids relapse before 6 months of follow-up. In addition, if a patient has not relapsed, they are more likely to relapse as each year passes. Analysis of the of audiometric relapse- free survival will enable the effect of future treatments to be compared and their capacity to reduce the rhythm of relapses. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  15. Evaluation of criteria for clinical control in a prospective, international, multicenter study of patients with COPD

    DEFF Research Database (Denmark)

    Miravitlles, Marc; Sliwinski, Pawel; Rhee, Chin Kook

    2018-01-01

    BACKGROUND: The concept of clinical control in COPD has been developed to help in treatment decisions, but it requires validation in prospective studies. METHOD: This international, multicenter, prospective study aimed to validate the concept of control in COPD [control = stability (no...... exacerbations or impairment in CAT scores) + low impact (low level of symptoms)]. Data from the screening visit was used to: investigate the level of control, compare characteristics of patients according to the control status, and perform a sensitivity analysis of the levels of control using either clinical...... criteria or questionnaires (COPD Assessment Test -CAT- or Clinical COPD Questionnaire -CCQ-). RESULTS: A total of 314 patients were analysed, mean age was 68.5 years and mean FEV1 was 52.6% of predicted. According to the prespecified criteria 21% of patients were classified as controlled, all of them...

  16. Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria.

    LENUS (Irish Health Repository)

    Gallagher, Paul F

    2012-02-03

    INTRODUCTION: Adverse drug events (ADEs) are associated with inappropriate prescribing (IP) and result in increased morbidity, mortality and resource utilisation. We used Beers\\' Criteria to determine the three-month prevalence of IP in a non-selected community-dwelling population of acutely ill older people requiring hospitalisation. METHODS: A prospective, observational study of 597 consecutive acute admissions was performed. Diagnoses and concurrent medications were recorded before hospital physician intervention, and Beers\\' Criteria applied. RESULTS: Mean patient age (SD) was 77 (7) years. Median number of medications was 5, range 0-13. IP occurred in 32% of patients (n = 191), with 24%, 6% and 2% taking 1, 2 and 3 inappropriate medications respectively. Patients taking >5 medications were 3.3 times more likely to receive an inappropriate medication than those taking < or =5 medications (OR 3.34: 95%, CI 2.37-4.79; P<0.001). Forty-nine per cent of patients with inappropriate prescriptions were admitted with adverse effects of the inappropriate medications. Sixteen per cent of all admissions were associated with such adverse effects. CONCLUSION: IP is highly prevalent in acutely ill older patients and is associated with polypharmacy and hospitalisation. However, Beers\\' Criteria cannot be used as a gold standard as they do not comprehensively address all aspects of IP in older people.

  17. Diagnostic efficiency of DSM-IV criteria for obsessive compulsive personality disorder in patients with binge eating disorder.

    Science.gov (United States)

    Grilo, C M

    2004-01-01

    This study examined the diagnostic efficiency of the DSM-IV criteria for obsessive compulsive personality disorder (OCPD) in patients with binge eating disorder (BED). Two hundred and eleven consecutive adult patients with axis I diagnoses of BED were reliably assessed with semi-structured diagnostic interviews. Conditional probabilities-sensitivity, specificity, positive predictive power (PPP), and negative predictive power (NPP)-were calculated for each of the eight criteria for OCPD, using the 'best-estimate' OCPD diagnosis as the standard. The diagnostic efficiencies of the OCPD criteria were variable, with three criteria failing to have predictive value (PPPOCPD based on performance and call into question the utility of some criteria.

  18. Criteria for Performing Cranial Computed Tomography for Chinese Patients With Mild Traumatic Brain Injury: Canadian Computed Tomography Head Rule or New Orleans Criteria?

    Science.gov (United States)

    Yang, Xiao-Feng; Meng, Yuan-Yuan; Wen, Liang; Wang, Hao

    2017-09-01

    Computed tomography (CT) provides the primary diagnostic evidence for traumatic brain injury (TBI), but few positive traumatic findings are discovered in patients with mild TBI. In China, there are no existing criteria for selecting patients with mild TBI to undergo CT, and almost all of these patients undergo cranial CT in the emergency department. This retrospective study was performed to evaluate the necessity of cranial CT among patients with mild TBI, as well as the feasibility of 2 popular criteria (Canadian CT head rule [CCHR] and New Orleans Criteria [NOC]) in China. Patients with mild TBI who underwent cranial CT within 24 hours of the trauma were included in our institute. Two neurosurgeons reviewed the CT images independently to identify positive CT findings. The sensitivity and specificity of CCHR and NOC for positive CT findings related to TBI were analyzed. Finally, this study included 625 patients. Positive CT findings related to TBI were discovered in 13.12% (82/625) of these patients on cranial CT, and 6.88% (43/625) of them were admitted to the hospital for further management. Ultimately, 11 patients (1.76%, 11/625) underwent neurosurgery. In this study, the sensitivities of both the CCHR and NOC were 100%, but the specificity of CCHR was 43.36% and that of NOC was 33.12%. Based on our study, both CCHR and NOC have high sensitivity for the detection of positive CT findings related to head trauma in patients with mild TBI.

  19. Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare.

    Science.gov (United States)

    Dolan, James G

    2010-01-01

    Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers.Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine "hard data" with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings.The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP).

  20. Use of routinely available clinical, nutritional, and functional criteria to classify cachexia in advanced cancer patients.

    Science.gov (United States)

    Vigano, Antonio A L; Morais, José A; Ciutto, Lorella; Rosenthall, Leonard; di Tomasso, Jonathan; Khan, Sarah; Olders, Henry; Borod, Manuel; Kilgour, Robert D

    2017-10-01

    Cachexia is a highly prevalent syndrome in cancer and chronic diseases. However, due to the heterogeneous features of cancer cachexia, its identification and classification challenge clinical practitioners. To determine the clinical relevance of a cancer cachexia classification system in advanced cancer patients. Beginning with the four-stage classification system proposed for cachexia [non-cachexia (NCa), pre-cachexia (PCa), cachexia (Ca) and refractory cachexia (RCa)], we assigned patients to these cachexia stages according to five classification criteria available in clinical practice: 1) biochemistry (high C-reactive protein or leukocytes, or hypoalbuminemia, or anemia), 2) food intake (normal/decreased), weight loss: 3) moderate (≤5%) or 4) significant (>5%/past six months) and 5) performance status (Eastern Cooperative Oncology Group Performance Status ≥ 3). We then determined if symptom severity, body composition changes, functional levels, hospitalizations and survival rates varied significantly across cachexia stages. Two-hundred and ninety-seven advanced cancer patients with primary gastrointestinal and lung tumors were included. Patients were classified into Ca (36%), PCa and RCa (21%, respectively) and NCa (15%). Significant (p cachexia stages for most of the outcome measures (symptoms, body composition, handgrip strength, emergency room visits and length of hospital stays) according to cachexia severity. Survival also differed between cachexia stages (except between PCa and Ca). Five clinical criteria can be used to stage cancer cachexia patients and predict important clinical, nutritional and functional outcomes. The lack of statistical difference between PCa and Ca in almost all clinical outcomes examined suggests either that the PCa group includes patients already affected by early cachexia or that more precise criteria are needed to differentiate PCa from Ca patients. More studies are required to validate these findings. Copyright © 2016

  1. Quality of life in patients with different constipation subtypes based on the Rome III criteria

    OpenAIRE

    M.C. Ruiz-López; E. Coss-Adame

    2015-01-01

    Background: Functional constipation and irritable bowel syndrome with constipation are highly prevalent and affect the quality of life of those who suffer from them. Aims: To evaluate quality of life in patients with functional constipation and irritable bowel disease in accordance with the Rome III criteria, using the PAC-QOL and SF-36 questionnaires. Materials and methods: A cross-sectional study was conducted using self-administered questionnaires. The PAC-QOL, SF-36, and Rome III co...

  2. What constitutes evidence-based patient information? Overview of discussed criteria.

    Science.gov (United States)

    Bunge, Martina; Mühlhauser, Ingrid; Steckelberg, Anke

    2010-03-01

    To survey quality criteria for evidence-based patient information (EBPI) and to compile the evidence for the identified criteria. Databases PubMed, Cochrane Library, PsycINFO, PSYNDEX and Education Research Information Center (ERIC) were searched to update the pool of criteria for EBPI. A subsequent search aimed to identify evidence for each criterion. Only studies on health issues with cognitive outcome measures were included. Evidence for each criterion is presented using descriptive methods. 3 systematic reviews, 24 randomized-controlled studies and 1 non-systematic review were included. Presentation of numerical data, verbal presentation of risks and diagrams, graphics and charts are based on good evidence. Content of information and meta-information, loss- and gain-framing and patient-oriented outcome measures are based on ethical guidelines. There is a lack of studies on quality of evidence, pictures and drawings, patient narratives, cultural aspects, layout, language and development process. The results of this review allow specification of EBPI and may help to advance the discourse among related disciplines. Research gaps are highlighted. Findings outline the type and extent of content of EBPI, guide the presentation of information and describe the development process. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  3. Prevalence of sarcopenia in elderly maintenance hemodialysis patients: the impact of different diagnostic criteria.

    Science.gov (United States)

    Lamarca, F; Carrero, J J; Rodrigues, J C D; Bigogno, F G; Fetter, R L; Avesani, C M

    2014-07-01

    The prevalence of sarcopenia on elderly maintenance hemodialysis (MHD) has been scarcely investigated. To investigate the prevalence of decreased muscle mass and strength alone or combined (true sarcopenia) in elderly patients on MHD according to different methods and cutoff limits. Additionally, we evaluated the agreement between dual energy x-ray absorptiometry (DXA) and surrogate methods for the assessment of muscle mass. Observational and cross-sectional study. Non-institutionalized 102 elderly (age > 60 years) patients on MHD. Sarcopenia was considered when the patient fit one criteria for low muscle mass assessed by DXA, bioelectrical impedance (BIA), sum of skinfold thicknesses (SKF), calf circumference and mid-arm muscle circumference (MAMC) and one for low muscle strength evaluated by handgrip dynamometer. Decreased muscle strength was found in 85% of the patients. The prevalence of decreased muscle mass varied from 4 to 73.5% and of sarcopenia (decreased muscle mass and strength combined) from 4 to 63%, depending on the method and cutoff limit applied. A small percentage of patients (2 to 15%) were classified as sarcopenic by more than one diagnostic criteria. The agreement between DXA and the surrogate methods to assess muscle mass showed better kappa coefficients with BIA (r=0.36; Psarcopenia is observed depending on the method and cutoff limit applied. This may limit extrapolate on to clinical practice. BIA and SKF were the surrogate methods to assess muscle mass with the best concordance with DXA in elderly MHD patients.

  4. Test-based exclusion diets in gastro-esophageal reflux disease patients: a randomized controlled pilot trial.

    Science.gov (United States)

    Caselli, Michele; Zuliani, Giovanni; Cassol, Francesca; Fusetti, Nadia; Zeni, Elena; Lo Cascio, Natalina; Soavi, Cecilia; Gullini, Sergio

    2014-12-07

    To investigate the clinical response of gastro-esophageal reflux disease (GERD) symptoms to exclusion diets based on food intolerance tests. A double blind, randomized, controlled pilot trial was performed in 38 GERD patients partially or completely non-responders to proton pump inhibitors (PPI) treatment. Fasting blood samples from each patients were obtained; leukocytotoxic test was performed by incubating the blood with a panel of 60 food items to be tested. The reaction of leukocytes (rounding, vacuolization, lack of movement, flattening, fragmentation or disintegration of cell wall) was then evaluated by optical microscopy and rated as follows: level 0 = negative, level 1 = slightly positive, level 2 = moderately positive, and level 3 = highly positive. A "true" diet excluding food items inducing moderate-severe reactions, and a "control" diet including them was developed for each patient. Then, twenty patients received the "true" diet and 18 the "control" diet; after one month (T1) symptoms severity was scored by the GERD impact scale (GIS). Hence, patients in the "control" group were switched to the "true" diet, and symptom severity was re-assessed after three months (T2). At baseline (T0) the mean GIS global score was 6.68 (range: 5-12) with no difference between "true" and control group (6.6 ± 1.19 vs 6.7 ± 1.7). All patients reacted moderately/severely to at least 1 food (range: 5-19), with a significantly greater number of food substances inducing reaction in controls compared with the "true" diet group (11.6 vs 7.0, P < 0.001). Food items more frequently involved were milk, lettuce, brewer's yeast, pork, coffee, rice, sole asparagus, and tuna, followed by eggs, tomato, grain, shrimps, and chemical yeast. At T1 both groups displayed a reduction of GIS score ("true" group 3.3 ± 1.7, -50%, P = 0.001; control group 4.9 ± 2.8, -26.9%, P = 0.02), although the GIS score was significantly lower in "true" vs "control" group (P = 0.04). At T2, after the diet

  5. The QUANTEC criteria for parotid gland dose and their efficacy to prevent moderate to severe patient-rated xerostomia.

    Science.gov (United States)

    Beetz, Ivo; Steenbakkers, Roel J H M; Chouvalova, Olga; Leemans, Charles R; Doornaert, Patricia; van der Laan, Bernard F A M; Christianen, Miranda E M C; Vissink, Arjan; Bijl, Henk P; van Luijk, Peter; Langendijk, Johannes A

    2014-05-01

    Recently, the Quantitative Analysis of Normal Tissue Effect in the Clinic (QUANTEC) Group defined dose-volume constraints for the parotid glands to avoid severe xerostomia. The aim of this study was to determine if application of these QUANTEC criteria also protected against moderate-to-severe patient-rated xerostomia. The study population consisted of 307 head and neck cancer patients treated with primary (chemo)radiotherapy, either with 3D-CRT (56%) or with IMRT (44%). All patients participated in a standard follow-up program in which radiation-induced toxicity and quality of life were prospectively assessed. Patients who met the QUANTEC criteria were classified as low risk and otherwise as high risk. In total, 41% of the patients (treated with 3D-CRT and IMRT) were classified as low risk patients. In the group treated with 3D-CRT and IMRT, it was possible to meet the QUANTEC criteria in 47% and 32% of the patients, respectively. Sparing the parotid glands with IMRT was considerably more difficult in patients with lymph node metastases and in patients with nasopharyngeal and oropharyngeal tumours. Low risk patients reported significantly less moderate-to-severe xerostomia than high risk patients. However, the predicted risk of elderly patients and patients with pre-existing minor patient-rated xerostomia at baseline was > 20%, even when the QUANTEC criteria were met. Significantly lower rates of radiation-induced patient-rated xerostomia were found among low risk patients treated according to the QUANTEC criteria, but these criteria do not completely protect against xerostomia. Particularly in elderly patients and patients already suffering from minor xerostomia at baseline, the QUANTEC criteria do not sufficiently protect against persistent, moderate-to-severe patient-rated xerostomia.

  6. Diagnostic criteria for CRPS I: differences between patient profiles using three different diagnostic sets.

    Science.gov (United States)

    Perez, Roberto S G M; Collins, Susan; Marinus, Johan; Zuurmond, Wouter W A; de Lange, Jaap J

    2007-11-01

    Complex Regional Pain Syndrome type I (CRPS I) is an illness which usually occurs due to major or minor tissue injury to the extremities. Because a unique pathophysiological mechanism for CRPS I has not yet been established, the diagnosis is based on observation and measurement of clinical symptoms and signs. In this study, a comparison was made between three sets of diagnostic criteria (the IASP, Bruehl et al. and Veldman et al.) based on patient reports and physicians' assessments of signs and symptoms associated with CRPS I, in 372 outpatients suspected of having CRPS I. Agreement between CRPS I diagnosis among the three sets was poor (kappa-range: 0.29-0.42), leading to positive CRPS I diagnoses according to Veldman et al.'s criteria in 218 cases (59%), according to the IASP in 268 cases (72%), and according to Bruehl et al. in 129 cases (35%). Significant differences in patient profiles were found between the diagnostic sets for the number of patients reporting continuing disproportionate pain, larger area affected than the initial trauma (both pCRPS I were found for reported hyperesthesia (SE+SP:165%), allodynia (160%), observed color asymmetry (162%), hyperesthesia (157%), temperature asymmetry (154%) and edema (152%). The lack of agreement between the different diagnostic sets for CRPS I and the different clinical profiles that result from it may lead to different therapeutic and study populations, hampering adequate treatment and scientific development for this illness. We propose explicit reference to diagnostic criteria used in studies, and registration in trials of a broad variety of CRPS I features, as used in this study, to make subgroup phenotyping and post hoc analyses based on different diagnostic criteria possible.

  7. Echocardiography Criteria for Structural Heart Disease in Patients With End-Stage Renal Disease Initiating Hemodialysis.

    Science.gov (United States)

    Hickson, LaTonya J; Negrotto, Sara M; Onuigbo, Macaulay; Scott, Christopher G; Rule, Andrew D; Norby, Suzanne M; Albright, Robert C; Casey, Edward T; Dillon, John J; Pellikka, Patricia A; Pislaru, Sorin V; Best, Patricia J M; Villarraga, Hector R; Lin, Grace; Williams, Amy W; Nkomo, Vuyisile T

    2016-03-15

    Cardiovascular disease among hemodialysis (HD) patients is linked to poor outcomes. The Acute Dialysis Quality Initiative Workgroup proposed echocardiographic (ECHO) criteria for structural heart disease (SHD) in dialysis patients. The association of SHD with important patient outcomes is not well defined. This study sought to determine prevalence of ECHO-determined SHD and its association with survival among incident HD patients. We analyzed patients who began chronic HD from 2001 to 2013 who underwent ECHO ≤1 month prior to or ≤3 months following initiation of HD (n = 654). Mean patient age was 66 ± 16 years, and 60% of patients were male. ECHO findings that met 1 or more and ≥3 of the new criteria were discovered in 87% and 54% of patients, respectively. Over a median of 2.4 years, 415 patients died: 108 (26%) died within 6 months. Five-year mortality was 62%. Age- and sex-adjusted structural heart disease variables associated with death were left ventricular ejection fraction (LVEF) ≤45% (hazard ratio [HR]: 1.48; confidence interval [CI]: 1.20 to 1.83) and right ventricular (RV) systolic dysfunction (HR: 1.68; CI: 1.35 to 2.07). An additive of higher death risk included LVEF ≤45% and RV systolic dysfunction rather than neither (HR: 2.04; CI: 1.57 to 2.67; p = 0.53 for test for interaction). Following adjustment for age, sex, race, diabetic kidney disease, and dialysis access, RV dysfunction was independently associated with death (HR: 1.66; CI 1.34 to 2.06; p < 0.001). SHD was common in our HD study population, and RV systolic dysfunction independently predicted mortality. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  8. Regulatory analysis on criteria for the release of patients administered radioactive material. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, S.; McGuire, S.A.

    1997-02-01

    This regulatory analysis was developed to respond to three petitions for rulemaking to amend 10 CFR parts 20 and 35 regarding release of patients administered radioactive material. The petitions requested revision of these regulations to remove the ambiguity that existed between the 1-millisievert (0.1-rem) total effective dose equivalent (TEDE) public dose limit in Part 20, adopted in 1991, and the activity-based release limit in 10 CFR 35.75 that, in some instances, would permit release of individuals in excess of the current public dose limit. Three alternatives for resolution of the petitions were evaluated. Under Alternative 1, NRC would amend its patient release criteria in 10 CFR 35.75 to match the annual public dose limit in Part 20 of 1 millisievert (0.1 rem) TEDE. Alternative 2 would maintain the status quo of using the activity-based release criteria currently found in 10 CFR 35.75. Under Alternative 3, the NRC would revise the release criteria in 10 CFR 35.75 to specify a dose limit of 5 millisieverts (0.5 rem) TEDE.

  9. Regulatory analysis on criteria for the release of patients administered radioactive material. Final report

    International Nuclear Information System (INIS)

    Schneider, S.; McGuire, S.A.

    1997-02-01

    This regulatory analysis was developed to respond to three petitions for rulemaking to amend 10 CFR parts 20 and 35 regarding release of patients administered radioactive material. The petitions requested revision of these regulations to remove the ambiguity that existed between the 1-millisievert (0.1-rem) total effective dose equivalent (TEDE) public dose limit in Part 20, adopted in 1991, and the activity-based release limit in 10 CFR 35.75 that, in some instances, would permit release of individuals in excess of the current public dose limit. Three alternatives for resolution of the petitions were evaluated. Under Alternative 1, NRC would amend its patient release criteria in 10 CFR 35.75 to match the annual public dose limit in Part 20 of 1 millisievert (0.1 rem) TEDE. Alternative 2 would maintain the status quo of using the activity-based release criteria currently found in 10 CFR 35.75. Under Alternative 3, the NRC would revise the release criteria in 10 CFR 35.75 to specify a dose limit of 5 millisieverts (0.5 rem) TEDE

  10. Radiation risk in pediatric patients: the need for criteria using radiopharmaceuticals activities

    International Nuclear Information System (INIS)

    Simas, Felipe; Instituto de Radioprotecao e Dosimetria; Velasques, Silvia M.

    2009-01-01

    The administration of radionuclides to children for diagnostic procedures should be carried out only if there is a strong clinical indication. The amount of activity administered may be reduced according to body weight, body surface area or other appropriate criteria. In Brazil, activities used for pediatric patients were evaluated (2003-2005) in sixteen selected public and private institutions in Northeast, Southeast and South geographical regions. The present work presents radiopharmaceuticals activities used in Brazil compared with international surveys performed in USA in 2005 and in the European Union in 2007. The activities per patient weight and minimum and maximum activities used per Brazilian installations were compared with those used in USA installations. Per patients, it was calculated the ideal minimum administered activity for each type of radiopharmaceutical by body weight according the Pediatric Dosage Card (PDC) criteria. It was not possible to compare activities for all radiopharmaceuticals used in Brazil because some are not more used outside, e.g. 131 I-NaI, which is replaced by 123 I-NaI for thyroid imaging. The discrepancy between activities used in Brazil compared with those used in USA and Europe may be attributed to the heterogeneity of Brazilian imaging equipment and lack for specific children protocols. The disadvantages for using fractions of adult activities are: necessity of minimum statistical counting for assurance of image quality and dependence upon equipment calibration. It was concluded that is necessary to establish standard criteria for radiopharmaceuticals activities applied to pediatric patients in Brazil and the risks due to additional activities should be estimated individually. (author)

  11. EVALUATION OF ULTRASOUND REMISSION CRITERIA IN PATIENTS WITH RHEUMATOID ARTHRITIS DURING TOCILIZUMAB THERAPY

    Directory of Open Access Journals (Sweden)

    Rita Aleksandrovna Osipyants

    2013-01-01

    Full Text Available Objective: to study the association of ultrasound (US remission criteria with the clinical and laboratory indicators of inflammatory activity, functional status, and X-ray changes in patients with rheumatoid arthritis (RA during tocilizumab (TCZ therapy.Subjects and methods. The trial included 36 patients with RA (meeting the 1987 American College of Rheumatology (ACR criteria who had received TCZ for 6 months. The authors made a clinical and laboratory assessment of RA activity (DAS28-CRP, and SDAI, functional impairments (HAQ index and US verification of wrist joint synovitis (a Voluson-i device, GE, 4-13-MHz linear transducer at baseline and 6 months after therapy. No signs of grey-scale (B-mode and power Doppler (PD synovitis (B = 0; PD = 0 or minimal B-mode synovitis, and not more one PD hypervascular signal (В ≤1; PD ≤1 were arbitrarily taken as US remission criteria. Destruction changes were evaluated by hand and foot X-ray using the Sharp method modified by van der Heijde (SHS.Results. After 6 months of therapy, about 80% of the patients in clinical remission retained moderate or significant synovitis, as evidenced by US studies. There were no clinical differences in clinical activity indices and functional impairments between the patients who were and were not in US remission (p > 0.05. The 12-month follow-up SHS score was significantly higher with the preservation of 6-month therapy signs of B-mode synovitis and PD hypervascularization (of not more than one signal than that in US remission (p < 0.05. There was no relationship of X-ray progression to the clinical and functional statuses (p > 0.05.Conclusion. Subclinical synovitis is observed even in clinical remission of RA. Destruction progression is significantlyrelated to synovitis persistence, as shown by ultrasonography.

  12. Exclusion of pituitary homeobox 2 gene polymorphism in vertical mandibular asymmetry patients: a preliminary study

    Science.gov (United States)

    Sofyanti, Ervina; Boel, Trelia; Soegiharto, Benny; Ilyas, Syafruddin; Irani Nainggolan, Lidya; Auerkari, Elza Ibrahim

    2018-03-01

    Pituitary Homeobox 2 (PITX2), is an active gene as a paired-related homeobox gene that encodes multiple isoforms. Its Nodal pathway in determination of left-right patterning during embryogenesis has been reported in satellite cells and expressed in adult human skeletal muscle. PITX2A and PITX2B are produced by alternative splicing and used of different promoters. PITX2C uses an alternative promoter located upstream of exon 4. PITX2D is produced by PITX2C alternative promoter and differential splicing. The 5’-primers and 3’- antisense primer were unique for each isoforms. Variability measurement in vertical dimension showed stronger genetic component than sagittal. This study aims to obtain the genotype marker of vertical mandibular asymmetry related to PITX2A and PITX2D isoform by visualization of the amplified product on stained gel to allele specific oligonucleotide between the case and control with Restriction Fragment Length Polymorphism (RFLP). Determination of vertical mandibular asymmetry based on condylar height asymmetry index of pre-treatment panoramic radiograph using Kjellberg’s technique whilst vertical mandibular growth pattern using lateral cephalogram. The differences of condylar height asymmetry in case-control based on vertical growth pattern was compared using Pearson’s chi-squared test. DNA extraction of 129 out-coming orthodontic patients in Universitas Sumatera Utara Dental Hospital were obtained from Buccal swab. Then DNA samples were amplified by Polymerase chain reaction (PCR) and digested with NciI restriction enzyme prior to electrophoresis visualization. There was no significant statistical difference in vertical mandibular asymmetry compared to vertical mandibular growth pattern. The RFLP analysis did not show any polymorphism for PITX2A and PITX2D isoform. All of the samples showed wild type homozygote. Further analysis method, except RFLP, were required to understand the genetic factor in the variance of vertical mandibular

  13. Automated classification of eligibility criteria in clinical trials to facilitate patient-trial matching for specific patient populations.

    Science.gov (United States)

    Zhang, Kevin; Demner-Fushman, Dina

    2017-07-01

    To develop automated classification methods for eligibility criteria in ClinicalTrials.gov to facilitate patient-trial matching for specific populations such as persons living with HIV or pregnant women. We annotated 891 interventional cancer trials from ClinicalTrials.gov based on their eligibility for human immunodeficiency virus (HIV)-positive patients using their eligibility criteria. These annotations were used to develop classifiers based on regular expressions and machine learning (ML). After evaluating classification of cancer trials for eligibility of HIV-positive patients, we sought to evaluate the generalizability of our approach to more general diseases and conditions. We annotated the eligibility criteria for 1570 of the most recent interventional trials from ClinicalTrials.gov for HIV-positive and pregnancy eligibility, and the classifiers were retrained and reevaluated using these data. On the cancer-HIV dataset, the baseline regex model, the bag-of-words ML classifier, and the ML classifier with named entity recognition (NER) achieved macro-averaged F2 scores of 0.77, 0.87, and 0.87, respectively; the addition of NER did not result in a significant performance improvement. On the general dataset, ML + NER achieved macro-averaged F2 scores of 0.91 and 0.85 for HIV and pregnancy, respectively. The eligibility status of specific patient populations, such as persons living with HIV and pregnant women, for clinical trials is of interest to both patients and clinicians. We show that it is feasible to develop a high-performing, automated trial classification system for eligibility status that can be integrated into consumer-facing search engines as well as patient-trial matching systems. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the US.

  14. Criteria of medical care evaluation in daily in-patient department in pediatrics

    Directory of Open Access Journals (Sweden)

    Grozdova T.U.

    2011-06-01

    Full Text Available The research goal is to work out criteria for the evaluation of medical care quality. Materials included 386 medical cards of daily in-patients, 216 medical cards of in-patients; 602 cards of analysis of case histories; 4 computer data bases. Methods of mathematical statistics were successfully used in the study. The comparative method of data analysis was applied to the research work. Intensity of medical care in values from 0,1 to 0,5 conditional units corresponded to requirements of criterion of estimation of medical care quality. Parameters of medicinal treatment were close to the standards of treatment in interval from 44,4 to 100%, as criterion of quality of medical care. Specific weight of apparatus and instrumental researches constituted an interval from 7, 4% to 22, 6%, forming corresponding criterion. Interval of effectiveness according to standards of consultations is from 0, 26 to 1, 04 conditional units. In conclusion the article stated that the characteristics for criteria to evaluate medical care in daily in-patient departments were worked out on the basis of indices obtained during the research work

  15. Criteria for Postoperative Mechanical Ventilation After Thymectomy in Patients With Myasthenia Gravis: A Retrospective Analysis.

    Science.gov (United States)

    Chigurupati, Keerthi; Gadhinglajkar, Shrinivas; Sreedhar, Rupa; Nair, Muraleedharan; Unnikrishnan, Madathipat; Pillai, Manjusha

    2018-02-01

    To determine the criteria for postoperative mechanical ventilation after thymectomy in patients with Myasthenia Gravis. Retrospective study. Teritiary care centre. 77 Myasthenia gravis patients operated for thymectomy were studied. After obtaining clearance from Institutional ethics committee, medical records of 77 patients with MG, who were operated for thymectomy between January 2005 and December 2015 were reviewed in a retrospective manner. Perioperative variables collected from the patient records were demographic data, duration of the disease, Osserman and Genkin classification, Anti-acetylcholine antibody (AChR) positivity, preoperative daily dose of drug, history of preoperative myasthenic crisis, preoperative vital capacity, technique of anesthesia, drugs used for anesthesia, perioperative complications, and duration of postoperative mechanical ventilation. The patients were divided into two groups, group I and group II consisting of those who required postoperative ventilation for 300 minutes, respectively. The determinants of prolonged postoperative ventilation were studied. The requirement of mechanical ventilation was higher in patients with higher Osserman's grade of myasthenia gravis. Duration of the disease had no effect on the duration of mechanical ventilation in myasthenic patients post thymectomy (p = 0.89). The patients with a preoperative history of myasthenic crisis had a requirement for prolonged mechanical ventilation (p=0.03). Patients with preoperative vital capacity mechanical ventilation with p values mechanical ventilation (p=0.026). Preoperative dose of pyridostigmine and the choice of continuation or discontinuation of antcholinesterases on the day of surgery had no influence on the duration of mechanical ventilation (p value of 0.19 and 0.36 respectively). Epidural analgesia intra and postoperatively significantly reduced the requirement of mechanical ventilation (p=0.006). The predictors of postoperative ventilation in myasthenic

  16. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients.

    LENUS (Irish Health Repository)

    Hamilton, Hilary

    2011-06-13

    Previous studies have not demonstrated a consistent association between potentially inappropriate medicines (PIMs) in older patients as defined by Beers criteria and avoidable adverse drug events (ADEs). This study aimed to assess whether PIMs defined by new STOPP (Screening Tool of Older Persons\\' potentially inappropriate Prescriptions) criteria are significantly associated with ADEs in older people with acute illness.

  17. Release criteria from hospitals of 131I thyrotoxicosis therapy patients in developing countries - case study

    International Nuclear Information System (INIS)

    Muhammad, W.; Faaruq, S.; Matiullah; Hussain, A.; Khan, A. A.

    2006-01-01

    The current release limit, recommended by the International Atomic Energy Agency (IAEA) (1), from hospitals of patients undergoing 131 I thyrotoxicosis therapy is ∼1100 MBq (∼30 mCi). Owing to the difference in socio-economic conditions, literacy rate, family system, etc., this release limit may not be applicable in most of the developing countries like Pakistan. Therefore, the prime objective of this case study was to re-evaluate the release criteria for 131 I thyrotoxicosis therapy patients by taking into account their lifestyle, economic conditions and other facilities such as availability of private/public transport, etc. In this context, systematic studies were carried out and 50 patients (i.e. 35 outpatients and 15 inpatients) at the Nuclear Medicine Oncology and Radiotherapy Inst. (NORI), Islamabad, were studied. Exposure rate at the surface of the body and at a distance of 1 m from the standing patient was measured. Results obtained from this study showed that the dose equivalent delivered by these patients to their family members (particularly children) and general public was higher than annual dose limits recommended by the International Commission for Radiation Protection in their report ICRP Publication 60 (2). In the light of this study, it is recommended that the release activity limit of ∼370 MBq (or dose rate level of ∼10 μSv h -1 at 1 m from the patient) be adopted instead of ∼1100 MBq in developing countries like Pakistan. (authors)

  18. Screening for Lynch syndrome using risk assessment criteria in patients with ovarian cancer.

    Science.gov (United States)

    Takeda, Takashi; Tsuji, Kosuke; Banno, Kouji; Yanokura, Megumi; Kobayashi, Yusuke; Tominaga, Eiichiro; Aoki, Daisuke

    2018-05-01

    Lynch syndrome is a cancer predisposition syndrome caused by germline mutation of DNA mismatch repair (MMR) genes. Lynch syndrome only causes about 0.4% of cases of ovarian cancer, which suggests that universal screening may not be cost-efficient. However, the frequency of Lynch syndrome in ovarian cancer is unclear in the Asian population. The goal of the study was to investigate a screening strategy using family history. The subjects were 129 patients with ovarian cancer. Clinical and family history were collected using a self-administered questionnaire, and Society of Gynecologic Oncology (SGO) criteria 2007 and PREMM₅ were used for risk assessment. Microsatellite instability, immunohistochemistry, and methylation of MMR genes were analyzed. Of the 129 cases, 25 (19.4%) met the SGO criteria, and 4 of these 25 had MSI-high and MMR deficiency. Two cases had loss of MSH2 and MSH6, indicating MSH2 mutation, and the other two had loss of MLH1 and PMS2, including one without MLH1 methylation indicating MLH1 mutation. These results show that screening using family history can detect Lynch syndrome in 12.0% (3/25) of ovarian cancer cases. The 3 cases were positive for PREMM₅, but negative for Amsterdam II criteria and revised Bethesda guidelines. Genetic testing in one case with MSH2 and MSH6 deficiency confirmed the diagnosis of Lynch syndrome with MSH2 mutation. This is the first study of screening for Lynch syndrome in ovarian cancer using clinical and family history in an Asian population. This approach may be effective for diagnosis in these patients. Copyright © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

  19. Performance Evaluation of Five Different Disseminated Intravascular Coagulation (DIC) Diagnostic Criteria for Predicting Mortality in Patients with Complicated Sepsis.

    Science.gov (United States)

    Ha, Sang Ook; Park, Sang Hyuk; Hong, Sang Bum; Jang, Seongsoo

    2016-11-01

    Disseminated intravascular coagulation (DIC) is a major complication in sepsis patients. We compared the performance of five DIC diagnostic criteria, focusing on the prediction of mortality. One hundred patients with severe sepsis or septic shock admitted to intensive care unit (ICU) were enrolled. Routine DIC laboratory tests were performed over the first 4 days after admission. The overall ICU and 28-day mortality in DIC patients diagnosed from five criteria (International Society on Thrombosis and Haemostasis [ISTH], the Japanese Association for Acute Medicine [JAAM], the revised JAAM [R-JAAM], the Japanese Ministry of Health and Welfare [JMHW] and the Korean Society on Thrombosis and Hemostasis [KSTH]) were compared. Both KSTH and JMHW criteria showed superior performance than ISTH, JAAM and R-JAAM criteria in the prediction of overall ICU mortality in DIC patients (odds ratio 3.828 and 5.181, P = 0.018 and 0.006, 95% confidence interval 1.256-11.667 and 1.622-16.554, respectively) when applied at day 1 after admission, and survival analysis demonstrated significant prognostic impact of KSTH and JMHW criteria on the prediction of 28-day mortality (P = 0.007 and 0.049, respectively) when applied at day 1 after admission. In conclusion, both KSTH and JMHW criteria would be more useful than other three criteria in predicting prognosis in DIC patients with severe sepsis or septic shock.

  20. Survey on patient doses in cardiology in Latin America. Criteria for high skin doses follow up

    International Nuclear Information System (INIS)

    Duran, Ariel; Duro, Ivanna; Lopez, Leonardo; Ramirez, Alfredo; Herrera, Carlos; Navarro, Joaquin; Rivarola, Carlos; Lopez, Jose A.

    2008-01-01

    Full text: As part of the International Action Plan for Protection of Patients and supporting by the IAEA, a survey on patient doses in fluoroscopy guided procedures in cardiology in Latin America has been conducted since 2006. One of the objectives of the survey was to set criteria for the identification and evaluation of high skin doses in a certain number of patients to recommend a clinical follow up for potential radiation injuries (more than 3 Gy at the skin). The used methodology for the survey was initiated with two dedicated workshops held in Santiago de Chile (2005) and San Jose de Costa Rica (2007) involving relevant cardiologists from 15 different Latin American Countries. Some sessions were also attended by experts from the Regulatory and Health Authorities. Standardized forms to collect demographic and patient dosimetric data were agreed. Considering that most of the involved centres had still not dosimeters installed in the cardiology x-ray systems, it was agreed to collect data on fluoroscopy time and total number of cine frames per procedure. Relevant factors influencing radio sensitivity of the skin were also collected. Data from 10 countries representing a sample of 709 patients were received during the first year. Procedures included were diagnostic (DG) (coronary angiography and electrophysiology studies), therapeutic (TH) (percutaneous transluminal coronary angioplasties, cardiac ablations and valvuloplasties) or including both DG and TH. A total of 26 patients (3.7%) were selected for potential high skin doses. Initial considered criteria for selection were more than 30 minutes of fluoroscopy, more than 3,000 cine frames per procedure or patients with more than 100 kg of weight. Maximum reported values were 72 minutes and 8,100 frames. In addition, 5 of these patients were diabetic, 6 have previous fluoroscopy procedures and 5 were over 95 kg. The percentage of selected cases for clinical follow up derived from potential skin injuries seem

  1. [Social and ethical criteria for prioritizing patients: a survey of students and health professionals in Portugal].

    Science.gov (United States)

    Pinho, Micaela Moreira

    2016-12-01

    This qualitative/quantitative study examines the ethical dilemma of microallocation of health resources. It seeks to identify and compare the opinion of two groups in Portuguese society - students and health professionals - on the importance of personal characteristics of patients at the moment of prioritizing them and if the choices can be explained by bioethical references of a utilitarian or deontological nature. Data were collected by means of a questionnaire administered to a sample of 180 students and 60 health professionals. Faced with hypothetical emergency scenarios, the respondents had to choose between two patients (distinguished by: age, gender, social responsibility, economic and employment situation, harmful health behaviors and criminal record), duly selecting who to treat and then justifying their choice. The results suggest the existence of differences in choices between the two groups, with health professionals revealing they are less prepared to accept the use of social criteria in a context of scarce resources and co-existence of utilitarian and deontological criteria, with a predominance of efficiency on the part of health professionals and equity on the part of students.

  2. Relaxing decision criteria does not improve recognition memory in amnesic patients.

    Science.gov (United States)

    Reber, P J; Squire, L R

    1999-05-01

    An important question about the organization of memory is whether information available in non-declarative memory can contribute to performance on tasks of declarative memory. Dorfman, Kihlstrom, Cork, and Misiaszek (1995) described a circumstance in which the phenomenon of priming might benefit recognition memory performance. They reported that patients receiving electroconvulsive therapy improved their recognition performance when they were encouraged to relax their criteria for endorsing test items as familiar. It was suggested that priming improved recognition by making information available about the familiarity of test items. In three experiments, we sought unsuccessfully to reproduce this phenomenon in amnesic patients. In Experiment 3, we reproduced the methods and procedure used by Dorfman et al. but still found no evidence for improved recognition memory following the manipulation of decision criteria. Although negative findings have their own limitations, our findings suggest that the phenomenon reported by Dorfman et al. does not generalize well. Our results agree with several recent findings that suggest that priming is independent of recognition memory and does not contribute to recognition memory scores.

  3. Diagnosis of hydrostatic versus increased permeability pulmonary edema with chest radiographic criteria in critically ILL patients

    International Nuclear Information System (INIS)

    Aberle, D.R.; Wiener-Kronish, J.P.; Webb, W.R.; Matthay, M.A.

    1987-01-01

    To evaluate chest radiographic criteria in distinguishing mechanisms of pulmonary edema, the authors studied 45 intubated patients with extensive edema. Edema type was clinically classified by the ratio of alveolar edema-to-plasma protein concentration in association with compatible clinical/hemodynamic parameters. Chest films were scored as hydrostatic, permeability, or mixed by three readers in blinded fashion based on cardiac size, vascular pedicle width, distribution of edema, effusions, peribronchial cuffs, septal lines, or air bronchograms. Overall radiographic score accurately identified 87% of patients with hydrostatic edema but only 60% of those with permeability edema. Edema distribution was most discriminating, with a patchy peripheral pattern relatively specific for clinical permeability edema. Hydrostatic features on chest radiograph were common with permeability edema, including effusions (36%), widened pedicle (56%), cuffs (72%), or septa (40%). The authors conclude that the chest radiograph is limited in distinguishing edema mechanism in the face of extensive pulmonary edema

  4. Tartrazine exclusion for allergic asthma.

    Science.gov (United States)

    Ardern, K D; Ram, F S

    2001-01-01

    Tartrazine is the best known and one of the most commonly used food additives. Food colorants are also used in many medications as well as foods. There has been conflicting evidence as to whether tartrazine causes exacerbations of asthma with some studies finding a positive association especially in individuals with cross-sensitivity to aspirin. To assess the overall effect of tartrazine (exclusion or challenge) in the management of asthma. A search was carried out using the Cochrane Airways Group specialised register. Bibliographies of each RCT was searched for additional papers. Authors of identified RCTs were contacted for further information for their trials and details of other studies. RCTs of oral administration of tartrazine (as a challenge) versus placebo or dietary avoidance of tartrazine versus normal diet were considered. Studies which focused upon allergic asthma, were also included. Studies of tartrazine exclusion for other allergic conditions such as hay fever, allergic rhinitis and eczema were only considered if the results for subjects with asthma were separately identified. Trials could be in either adults or children with asthma or allergic asthma (e.g. sensitivity to aspirin or food items known to contain tartrazine). Study quality was assessed and data abstracted by two reviewers independently. Outcomes were analysed using RevMan 4.1.1. Ninety abstracts were found, of which 18 were potentially relevant. Six met the inclusion criteria, but only three presented results in a format that permitted analysis and none could be combined in a meta-analysis. In none of the studies did tartrazine challenge or avoidance in diet significantly alter asthma outcomes. Due to the paucity of available evidence, it is not possible to provide firm conclusions as to the effects of tartrazine on asthma control. However, the six RCTs that could be included in this review all arrived at the same conclusion. Routine tartrazine exclusion may not benefit most patients

  5. Hepatorenal syndrome in patients with cirrhosis of liver according to 2007 international ascites club criteria

    International Nuclear Information System (INIS)

    Seetlani, N.K.; Memon, A.R.; Iftikhar, F.; Fazel, P.A.

    2016-01-01

    Heptorenal syndrome is a complication of cirrhosis of liver and is characterized by progressive renal failure. This study was done to determine the frequency of hepatorenal syndrome according to 2007 international ascites club criteria among patients of cirrhosis attending Medical Units of Civil hospital Karachi. Methods: This is a cross-sectional study conducted on the hospitalized patients in the Department of Medicine-Civil Hospital Karachi from 01-04-2014 to 30-09-2014 where total 265 patients of either gender, age >18 years and <60 years and diagnosed case of CLD were included. Patients with shock, SIRS, sepsis, known cases of intrinsic renal diseases, or history of diabetes mellitus, Hypertension or connective tissue diseases were excluded. Mean±SD were expressed for continuous variable like, age, duration of CLD. Frequency and percentages of other categorical variables, i.e., gender, residence were expressed. Effect modification was tested through Chi-square with p-value <0.05 significant. Results: The mean±SD age of patient was 48.23+-7.87 years with range 18-60 years. Mean±SD duration of chronic liver disease was 5.60±1.92 years with a range of 3-12 years. More than 155 (58%) participants in this study were male and females were 110 (41.51%). More than 36 (13%) were of age less than and equal to 40 years; 121 (45.67%) were from 41-50 years, while 108 (40.75%) were from age 51-60 years. More than 176 (66.41%) belonged to rural areas while only 89 (33.58%) belonged to urban areas. The study observed that according to IAC 2007 criteria of diagnosis of hepatorenal syndrome 15.09% of patients with cirrhosis were found to have HRS. Conclusion: Hepatorenal syndrome represents the end stage of a sequence of reduction of renal perfusion induced by advanced liver failure. Almost every seventh patient of Cirrhosis can develop hepatorenal Syndrome. This should be looked up at an early stage so that it can be prevented. (author)

  6. [Follow-up of patients with osteoarthritis. Coordinated management and criteria for referral between healthcare levels].

    Science.gov (United States)

    Nieto Pol, Enrique

    2014-01-01

    The correct management of osteoarthritis requires an accurate diagnosis, evaluation of its spread and functional repercussions, and the application of comprehensive and effective individually-tailored treatment aimed at relieving pain and improving physical function with a consequent improvement in quality of life; treatment should also aim to prevent or delay disease progression and its effects. In the National Health Service, primary care is the basic level and the first point of access to healthcare; this level guarantees the continuity of care, coordinates patients, and regulates clinical workflow. Family physicians coordinate the healthcare processes related to chronic diseases and are responsible for the management, diagnosis, evaluation, treatment, and follow-up of patients with osteoarthritis. The clinical practice guidelines internationally accepted as the standard of care for the management of osteoarthritis should be adapted by both Spanish health planning strategies and clinical practice guidelines to the Spanish healthcare setting. The comprehensive assessment of osteoarthritis includes evaluation of its effects on the patient's physical function and quality of life; formulating a treatment plan in collaboration with the patient and adapted to his or her comorbidities; providing advice on basic treatments and their risks and benefits; and carrying out an individually-tailored periodic review. Referral criteria are based on diagnostic confirmation, poor treatment response, and surgical evaluation. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  7. STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria.

    LENUS (Irish Health Repository)

    Gallagher, Paul

    2012-02-03

    Introduction: STOPP (Screening Tool of Older Persons\\' potentially inappropriate Prescriptions) is a new, systems-defined medicine review tool. We compared the performance of STOPP to that of established Beers\\' criteria in detecting potentially inappropriate medicines (PIMs) and related adverse drug events (ADEs) in older patients presenting for hospital admission. METHODS: we prospectively studied 715 consecutive acute admissions to a university teaching hospital. Diagnoses, reason for admission and concurrent medications were recorded. STOPP and Beers\\' criteria were applied. PIMs with clear causal connection or contribution to the principal reason for admission were determined. RESULTS: median patient age (interquartile range) was 77 (72-82) years. Median number of prescription medicines was 6 (range 0-21). STOPP identified 336 PIMs affecting 247 patients (35%), of whom one-third (n = 82) presented with an associated ADE. Beers\\' criteria identified 226 PIMs affecting 177 patients (25%), of whom 43 presented with an associated ADE. STOPP-related PIMs contributed to 11.5% of all admissions. Beers\\' criteria-related PIMs contributed to significantly fewer admissions (6%). CONCLUSION: STOPP criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers\\' criteria. This finding has significant implications for hospital geriatric practice.

  8. Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria

    Science.gov (United States)

    Faghih, Mahya; Gonzalez, Francisco Garcia; Makary, Martin A.; Singh, Vikesh K.

    2018-01-01

    Purpose of review Critical review of the indications for total pancreatectomy and highlight limitations in current diagnostic criteria for chronic pancreatitis. Recent findings The diagnosis of noncalcific chronic pancreatitis remains controversial because of an overreliance on nonspecific imaging and laboratories findings. Endoscopic ultrasound, s-magnetic resonance cholangiopancreatography, and/or endoscopic pancreatic function testing are often used to diagnose noncalcific chronic pancreatitis despite the fact that there is no gold standard for this condition. Abdominal pain is not specific for chronic pancreatitis and is more likely to be encountered in patients with functional gastrointestinal disorders based on the high incidence of these conditions. The duration of pain and opioid analgesic use results in central sensitization that adversely affects pain outcomes after total pancreatectomy. An alcoholic cause is associated with poorer pain outcomes after total pancreatectomy. Summary The lack of a gold standard for noncalcific chronic pancreatitis limits the diagnostic accuracy of imaging and laboratory tests. The pain of chronic pancreatitis is nonspecific and is affected by duration, preoperative opioid use, and cause. These factors will need to be considered in the development of future selection criteria for this morbid surgery. PMID:28700371

  9. Pathophysiology of functional heartburn based on Rome III criteria in Japanese patients.

    Science.gov (United States)

    Tamura, Yasuhiro; Funaki, Yasushi; Izawa, Shinya; Iida, Akihito; Yamaguchi, Yoshiharu; Adachi, Kazunori; Ogasawara, Naotaka; Sasaki, Makoto; Kaneko, Hiroshi; Kasugai, Kunio

    2015-04-28

    To investigate the pathophysiology of functional heartburn (FH) in Japanese patients. A total of 111 patients with proton pump inhibitor (PPI)-refractory non-erosive gastroesophageal reflux disease underwent intraesophageal pressure testing and 24-h multichannel intraluminal impedance-pH (24MII-pH) testing. The patients also completed several questionnaires while they were receiving the PPI treatment, including the questionnaire for the diagnosis of reflux disease (QUEST), the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), the gastrointestinal symptoms rating scale (GSRS), SF-36, and the Cornell Medical Index (CMI). The subjects were classified into FH and endoscopy-negative reflux disease (ENRD) groups based on the Rome III criteria. Thirty-three patients with esophageal motility disorder were excluded from this study, while 22 patients with abnormal esophageal acid exposure time (pH-POS) and 34 with hypersensitive esophagus (HE) were included in the ENRD group. The FH group included 22 patients with no reflux involvement. Sex, age, and body mass index did not differ significantly between the groups. The mean SF-36 values were < 50 (normal) for all scales in these groups, with no significant differences. The GSRS scores in these groups were not different and showed overlap with other gastrointestinal symptoms. The QUEST and the FSSG scores did not differ significantly between the groups. Neuroticism was diagnosed using the CMI questionnaire in 17 of the 78 included subjects within the pH-POS (n = 4), HE (n = 8), and FH (n = 5) groups, with no significant differences. Clinical characteristics of the FH and PPI-refractory ENRD groups were similar. Therefore, esophageal function should be examined via manometry and 24MII-pH testing to differentiate between them.

  10. The use of an exclusion-based risk-assessment model for venous thrombosis improves uptake of appropriate thromboprophylaxis in hospitalized medical patients.

    Science.gov (United States)

    Bagot, C; Gohil, S; Perrott, R; Barsam, S; Patel, R K; Arya, R

    2010-08-01

    Venous thromboembolism is a common condition in hospitalized medical patients. Numerous studies have demonstrated that low molecular weight heparin significantly reduces this risk but, despite this, the use of thromboprophylaxis remains poor. To evaluate the use of an exclusion based risk-assessment model (RAM) for venous thrombosis in improving the uptake of appropriate thromboprophylaxis in hospitalized medical patients. A survey with a subsequent audit cycle of three separate audits over 36 months. 497 hospitalized patients with acute medical conditions on general medical wards were audited at a secondary care centre in London, UK. The survey and subsequent audits were performed by reviewing the notes and medication charts of medical patients, prior to the launch of the RAM and at 12, 28 and 36 months following its introduction. Prior to launching the RAM, 49% of hospitalized medical patients received appropriate thromboprophylaxis. This did not change 12 months after the RAM was introduced but increased significantly to 71% following formal education of the health care professionals involved in thromboprophylaxis prescription. This improvement was maintained as demonstrated by a subsequent audit 8 months later (75.9%). The introduction of a simple exclusion-based RAM for venous thrombosis in medical patients significantly improved delivery of thromboprophylaxis. The successful uptake of the RAM appears to have been dependent on direct education of those health carers involved in its use. A similar exclusion-based model used nationally could have a significant impact on the burden of VTE currently experienced in the UK.

  11. Comparing Western and Eastern criteria for sarcopenia and their association with survival in patients with pancreatic cancer.

    Science.gov (United States)

    Wu, Chih-Horng; Chang, Ming-Chu; Lyadov, Vladimir K; Liang, Po-Chin; Chen, Chyi-Mong; Shih, Tiffany Ting-Fang; Chang, Yu-Ting

    2018-02-20

    Sarcopenia and cachexia are associated with pancreatic cancer and serve as important adverse prognostic factors. Body composition can be analyzed by routine computed tomography (CT) for cancer staging and has been used to study many types of cancer. The CT measurements are robust, but the diagnostic criteria for sarcopenia vary among different studies. Age, sex and race are important factors that affect muscle and fat masses. This study aimed to analyze the effect of different sarcopenia diagnostic criteria on the prognosis of patients with pancreatic cancer. Patients with newly diagnosed pancreatic cancer at National Taiwan University Hospital between October 2013 and October 2016 were retrospectively reviewed in this study. Body composition was assessed using cross-sectional CT images to calculate the total skeletal muscle (TSM) index. The concordance and interobserver variability of the TSM measurements were evaluated using both the Western criteria and the Eastern criteria. Kaplan-Meier analyses and the Cox proportional hazard ratio with two different diagnostic criteria for sarcopenia were used to compare the effect on overall survival (OS). A total of 146 patients with pancreatic cancer were enrolled. The TSM index measured by the Western institute was highly correlated with that measured by the Eastern institute (r = 0.953, p Western criteria and 11.0% (16/146) by the Eastern criteria, and only low agreement was found between the Western and Eastern criteria (Kappa value = 0.028, p = 0.149). Patients who were sarcopenic by the Western criteria showed no significant difference in OS versus those who were not sarcopenic (p = 0.807). However, patients who were sarcopenic by the Eastern criteria showed a significant difference in OS versus those who were not sarcopenic in a univariate analysis (p = 0.008) and multivariate analysis after adjustment for AJCC stage (p = 0.014). Our study demonstrates that different diagnostic criteria may result in

  12. Behçet's disease patients with multiple sclerosis-like features: discriminative value of Barkhof criteria.

    Science.gov (United States)

    Akman-Demir, Gulsen; Mutlu, Melike; Kiyat-Atamer, Asli; Shugaiv, Erkingul; Kurtuncu, Murat; Tugal-Tutkun, Ilknur; Tuzun, Erdem; Eraksoy, Mefkure; Bahar, Sara

    2015-01-01

    Behçet's disease (BD) is a systemic auto-inflammatory disorder of unknown cause, which may affect the central nervous system in around 5% of the patients [neuro-BD (NBD)], usually causing large lesions encompassing brainstem, diencephalon and basal ganglia regions. Occasionally NBD patients present with white matter lesions necessitating differential diagnosis from multiple sclerosis (MS). In this study, the efficacy of Barkhof criteria was tested in diagnostic differentiation of NBD and MS. Charts and MRIs of 84 NBD patients were retrospectively evaluated. Clinical and radiological features of NBD patients fulfilling (Barkhof+) and not fulfilling Barkhof criteria (Barkhof-) were compared. While the Barkhof- patients (n=73) mostly displayed typical large lesions covering brainstem, diencephalon and basal ganglia regions and neurological findings consistent with brainstem involvement, all Barkhof+ (n=11) patients demonstrated MS-like white matter lesions, fulfilled McDonald's criteria and showed reduced frequency of brainstem symptoms and increased frequency of hemiparesis, hemihypesthesia and spinal cord symptoms. Moreover, the Barkhof+ group had more female patients, increased number of attacks, higher rate of oligoclonal band positivity and less patients with cerebrospinal fluid pleocytosis. A subgroup of BD patients with neurological complaints displays MS-like lesions, fulfills the clinical and radiological criteria of MS and presents with clinical and laboratory features resembling those of MS rather than NBD. These results suggest that Barkhof+ patients are either an overlapping group between NBD and MS, or they represent MS patients with concomitant systemic findings of BD, rather than NBD. Barkhof criteria appear to be effective in discriminating these patients.

  13. Factor structure of DSM-IV criteria for obsessive compulsive personality disorder in patients with binge eating disorder.

    Science.gov (United States)

    Grilo, C M

    2004-01-01

    To examine the factor structure of DSM-IV criteria for obsessive compulsive personality disorder (OCPD) in patients with binge eating disorder (BED). Two hundred and eleven consecutive out-patients with axis I diagnoses of BED were reliably assessed with semi-structured diagnostic interviews. The eight criteria for the OCPD diagnosis were examined with reliability and correlational analyses. Exploratory factor analysis was performed to identify potential components. Cronbach's coefficient alpha for the OCPD criteria was 0.77. Principal components factor analysis with varimax rotation revealed a three-factor solution (rigidity, perfectionism, and miserliness), which accounted for 65% of variance. The DSM-IV criteria for OCPD showed good internal consistency. Exploratory factor analysis, however, revealed three components that may reflect distinct interpersonal, intrapersonal (cognitive), and behavioral features.

  14. Prevalence and clinical characteristics of white-coat hypertension based on different definition criteria in untreated and treated patients.

    Science.gov (United States)

    de la Sierra, Alejandro; Vinyoles, Ernest; Banegas, José R; Segura, Julián; Gorostidi, Manuel; de la Cruz, Juan J; Ruilope, Luis M

    2017-12-01

    The prevalence and associated risks of white-coat hypertension (WCH) are still a matter of debate. We aimed to assess differences in prevalence and associated conditions of WCH defined on the basis of the normality of all daytime, night-time, and 24-h blood pressure (BP), only daytime, or only 24-h BP. We selected 115 708 patients (45 020 untreated and 70 688 treated) from the Spanish Ambulatory BP Monitoring Registry. WCH was estimated in patients with elevated office BP (≥140 and/or 90 mmHg) by using normal daytime (definition criteria. Only diagnostic criteria which considers the normality of all ambulatory periods identifies patients with cardiovascular risk similar to normotensive patients. These results support using such criteria for a more accurate definition of WCH.

  15. Modern digital plain-radiography of the whole spine in scoliosis patients. Dose reduction and quality criteria

    International Nuclear Information System (INIS)

    Kloth, Jost Karsten; Stiller, W.; Kauczor, H.U.; Weber, M.A.

    2013-01-01

    To reduce the radiation exposure of plain radiographs of the entire spine depending on specific indications, since these are frequently performed examinations of children and young adults with scoliosis and to determine objective quality control criteria to ensure accurate assessment. In this prospective randomized study 323 patients underwent plain-radiography of the entire spine with standard and 50 % reduced dose. In an experimental pilot-study this target-dose was determined using an Alderson-Phantom. The evaluation of the experimental radiographs, as well as, the randomized plain-radiographs was conducted using the following criteria: endplates (Cobb-angle), spinal process and pedicel (rotation), lateral margin of the vertebral body (lateral alignment), identification of C7 / S1 (perpendicular). Two radiologists evaluated these criteria using a score ranging from 1 (definitely assessable) to 4 (not assessable). If one single criteria was evaluated with a score of 3 or more points or more than 2 criteria with 2 points, the radiograph was scored as ''not assessable''. The statistical analysis was conducted as a non-inferiority-trial. Seven (2.4 %) of the 290 examined x-rays were scored as not assessable. There was no statistic inferiority between the examinations with standard or reduced dose, while singular assessment of the defined criteria was likewise dose-independent. Plain-radiography of the total spine in patients with scoliosis can be performed with a dose reduction of 50 % without a loss of validity. The obtained quality control criteria were clinically applicable. (orig.)

  16. A prospective observational study comparing a physiological scoring system with time-based discharge criteria in pediatric ambulatory surgical patients.

    Science.gov (United States)

    Armstrong, James; Forrest, Helen; Crawford, Mark W

    2015-10-01

    Discharge criteria based on physiological scoring systems can be used in the postanesthesia care unit (PACU) to fast-track patients after ambulatory surgery; however, studies comparing physiological scoring systems with traditional time-based discharge criteria are lacking. The purpose of this study was to compare PACU discharge readiness times using physiological vs time-based discharge criteria in pediatric ambulatory surgical patients. We recorded physiological observations from consecutive American Society of Anesthesiologists physical status I-III patients aged 1-18 yr who were admitted to the PACU after undergoing ambulatory surgery in a tertiary academic pediatric hospital. The physiological score was a combination of the Aldrete and Chung systems. Scores were recorded every 15 min starting upon arrival in the PACU. Patients were considered fit for discharge once they attained a score ≥12 (maximum score, 14), provided no score was zero, with the time to achieve a score ≥12 defining the criteria-based discharge (CBD) time. Patients were discharged from the PACU when both the CBD and the existing time-based discharge (TBD) criteria were met. The CBD and TBD data were compared using Kaplan-Meier and log-rank analysis. Observations from 506 children are presented. Median (interquartile range [IQR]) age was 5.5 [2.8-9.9] yr. Median [IQR] CBD and TBD PACU discharge readiness times were 30 [15-45] min and 60 [45-60] min, respectively. Analysis of Kaplan-Meier curves indicated a significant difference in discharge times using the different criteria (hazard ratio, 5.43; 95% confidence interval, 4.51 to 6.53; P < 0.001). All patients were discharged home without incident. This prospective study suggests that discharge decisions based on physiological criteria have the potential for significantly speeding the transit of children through the PACU, thereby enhancing PACU efficiency and resource utilization.

  17. Patients Suspected of Irritable Bowel Syndrome-Cross-Sectional Study Exploring the Sensitivity of Rome III Criteria in Primary Care

    DEFF Research Database (Denmark)

    Engsbro, Anne Line; Begtrup, Luise Mølenberg; Kjeldsen, Jens

    2013-01-01

    The Rome III criteria for irritable bowel syndrome (IBS) are recommended by guidelines to help identify the syndrome. The majority of IBS patients are managed in primary care, where a pragmatic approach to diagnosis is usually adopted, using clinical judgment and knowledge about the patient. Many...

  18. Characteristics of complex regional pain syndrome in patients referred to a tertiary pain clinic by community physicians, assessed by the Budapest clinical diagnostic criteria.

    Science.gov (United States)

    Mailis-Gagnon, Angela; Lakha, Shehnaz Fatima; Allen, Matti D; Deshpande, Amol; Harden, Robert Norman

    2014-11-01

    The aim of this study was to describe the characteristics of patients referred with complex regional pain syndrome (CRPS) diagnosis to a tertiary care pain center. Descriptive chart review study of all patients referred by family physicians or community specialists as having CRPS (2006-2010). Data extraction included demographics, pain ratings, and diagnosis utilizing the Budapest CRPS criteria. The study population consisted of 54 subjects (male [M] =7, female [F] =47). Only 27.7% were classified as CRPS by the clinical expert. Four additional subjects carrying other diagnoses but found to have CRPS were added to the analysis. The non-CRPS group consisted of 39 subjects (M=8, F=31) and the CRPS group of 19 (M=2, F=17). CRPS patients were statistically significantly more likely to 1) have suffered a fracture; 2) report symptoms in each of the four symptom categories, as well as signs in three or four categories collectively; and 3) have allodynia/hyperalgesia alone or in combination (85/90%) as compared with the non-CRPS group (23/25%, respectively). The non-CRPS group was much more likely to report no symptoms or signs at all in the different symptom and sign categories. Of the 39 non-CRPS patients, 74% had other diagnosable entities (1/3 suffering from specific neuropathic pain conditions, e.g., radiculopathy, diabetic neuropathy, etc. and 2/3 from discreet musculoskeletal entities), while 18% were diagnosed with psychogenic pain disorders including conversion reaction associated with immobility or paralysis. Besides fulfilling the Budapest CRPS diagnostic criteria, the most important other factor for diagnosing CRPS is the exclusion of a neuropathic, musculoskeletal, or non-biomedical condition accounting for the presentation. Wiley Periodicals, Inc.

  19. CEC quality criteria for diagnostic radiographic images and patient exposure trial

    International Nuclear Information System (INIS)

    Nahrstedt, U.; Wall, B.; Maccia, C.; Moores, B.M.; Padovani, R.

    1990-01-01

    The intention of this report has been to present the results of a multinational trial set up by a study group of the radiation protection programme of the CEC. In view of proceeding towards the harmonization and the optimization of the radiological techniques commonly used in different European countries, the relevance of quality criteria for radiographic images together with dose requirements were checked on about 900 examined patients. Due to the type of X-ray projections considered, more than 1 200 questionnaires concerning the real X-ray films were therefore collected and evaluated through a scoring system. Such an approach was relevant and contributed to providing practical considerations on how to reduce and optimize patient received dose while keeping the essential medical information imaged on the film. Indeed the results obtained allowed identification of technical modalities corresponding to that objective. Furthermore, analysis of results revealed two main areas which should be further taken into consideration: - personnel training in radiation protection (radiologists and radiographers), establishment of quality assurance programmes in diagnostic radiology (good usage of radiological equipment and reduction of wasted films)

  20. Early response to sibutramine in patients not meeting current label criteria: preliminary analysis of SCOUT lead-in period

    DEFF Research Database (Denmark)

    Caterson, Ian; Coutinho, Walmir; Finer, Nick

    2010-01-01

    The Sibutramine Cardiovascular Outcomes (SCOUT) trial protocol defines a patient population predominantly outside current European Union label criteria. This article explores responses to sibutramine during the 6-week, single-blind, lead-in period between patients who conformed to the label...... requirements ("conformers") and those who did not ("nonconformers"). SCOUT is an ongoing, randomized, double-blind, placebo-controlled outcome trial in overweight/obese patients at high risk of a cardiovascular event. In total, 10,742 patients received sibutramine and weight management during the lead...... with sibutramine confirms its good tolerability and efficacy in patients who meet current label criteria. Preliminary data from high-risk patients for whom sibutramine is currently contraindicated suggest a low discontinuation rate and few serious adverse events but confirmation from the SCOUT outcome data...

  1. Admission Physiology Criteria After Injury on the Battlefield Predict Medical Resource Utilization and Patient Mortality

    National Research Council Canada - National Science Library

    Eastridge, Brian J; Owsley, Jimmie; Sebesta, James; Beekley, Alec; Wade, Charles; Wildzunas, Robert; Rhee, Peter; Holcomb, John

    2006-01-01

    .... We hypothesized that easily measurable admission physiologic criteria and injury site as well as injury severity calculated after diagnostic evaluation or surgical intervention, would be strongly...

  2. Morphological and functional criteria of hepatobiliary scintigraphy with IDA derivatives in patients with hepatocellular jaundice

    International Nuclear Information System (INIS)

    Biersack, H.J.; Breuel, H.P.; Altland, H.; Bell, E.

    1979-01-01

    In 31 Patients with histologically proven hepatocellular jaundice hepatobiliary scintigraphy with Tc-99m labelled IDA derivatives was performed. Results were classified under morphological (demonstration of liver parenchyma, ductus choledochus, bile ducts, gallbladder, kidney) and functional (Tsub(max), halftime of bile excretion, appearance of activity in ductus choledochus, gallbladder, and intestines) criteria. The liver parenchyma could be demonstrated in 90.3% of cases, ductus choledochus in 71% and the gallbladder in 72.4%. The type of tracer excretion into the intestines showed 9.5% activity accumulation in the gallbladder with late bile excretion into the intestines and 90.5% early activity excretion into the duodenum with late filling of the gallbladder. The intrahepatic bile ducts were demonstrated in 22.6% (left hepatic duct) and 6.5% (right hepatic duct). In 35.5% of cases the kidneys were still visible after 15 min p.i. All cases showed - sometimes delayed - bile excretion into the GI tract. The time of appearance of activity in ductus choledochus (18.4 min) and gallbladder (39.5 min) was delayed. The liver histogram showed likewise delayed values concerning Tsub(max) (14.3 min) and half life of tracer excretion (> 30 min) when compared to controls. The differentiation of hepatocellular jaundice from obstructive jaundice is possible by the demonstration of bile excretion into the intestines, normal width of the bile ducts, and filling of the gallbladder. (orig.) [de

  3. Prediction of Depression in Cancer Patients With Different Classification Criteria, Linear Discriminant Analysis versus Logistic Regression.

    Science.gov (United States)

    Shayan, Zahra; Mohammad Gholi Mezerji, Naser; Shayan, Leila; Naseri, Parisa

    2015-11-03

    Logistic regression (LR) and linear discriminant analysis (LDA) are two popular statistical models for prediction of group membership. Although they are very similar, the LDA makes more assumptions about the data. When categorical and continuous variables used simultaneously, the optimal choice between the two models is questionable. In most studies, classification error (CE) is used to discriminate between subjects in several groups, but this index is not suitable to predict the accuracy of the outcome. The present study compared LR and LDA models using classification indices. This cross-sectional study selected 243 cancer patients. Sample sets of different sizes (n = 50, 100, 150, 200, 220) were randomly selected and the CE, B, and Q classification indices were calculated by the LR and LDA models. CE revealed the a lack of superiority for one model over the other, but the results showed that LR performed better than LDA for the B and Q indices in all situations. No significant effect for sample size on CE was noted for selection of an optimal model. Assessment of the accuracy of prediction of real data indicated that the B and Q indices are appropriate for selection of an optimal model. The results of this study showed that LR performs better in some cases and LDA in others when based on CE. The CE index is not appropriate for classification, although the B and Q indices performed better and offered more efficient criteria for comparison and discrimination between groups.

  4. Outcome Criteria for Discharging the Patient With a New Ostomy From Home Health Care: A WOCN Society Consensus Conference.

    Science.gov (United States)

    Colwell, Janice C; Kupsick, Phyllis T; McNichol, Laurie L

    2016-01-01

    The Wound, Ostomy and Continence Nurses Society hosted a consensus panel of expert ostomy clinicians who were tasked with identifying minimal discharge criteria for home care patients with a new fecal or urinary diversion. Shortened hospital inpatient stays, higher patient acuity, and limited access to ostomy specialists send patients with new ostomies home with multiple educational and adjustment needs related to a new stoma. The Society recognized the lack of evidence-based ostomy practice and supported the work of the panel to develop statements that defined elements of the care plan for the patient or caregiver in home care who is adapting to living with a stoma. Eighteen statements were developed that provide minimum discharge criteria for the patient with a new ostomy in the home care setting. Support based upon current evidence as well as expert opinion with implementation strategies are offered for each statement.

  5. Relevance of Follow-Up in Patients with Core Clinical Criteria for Alzheimer Disease and Normal CSF biomarkers.

    Science.gov (United States)

    Vercruysse, Olivier; Paquet, Claire; Gabelle, Audrey; Delbeuck, Xavier; Blanc, Frederic; Wallon, David; Dumurgier, Julien; Magnin, Eloi; Martinaud, Olivier; Jung, Barbara; Bousiges, Olivier; Lehmann, Sylvain; Delaby, Constance; Quillard-Murain, Muriel; Peoc'h, Katell; Laplanche, Jean-Louis; Bouaziz-Amar, Elodie; Hannequin, Didier; Sablonniere, Bernard; Buee, Luc; Hugon, Jacques; Schraen, Susanna; Pasquier, Florence; Bombois, Stephanie

    2018-01-09

    Few patients with a normal cerebrospinal fluid (CSF) biomarker profile fulfill the clinical criteria for Alzheimer disease (AD). The aim of this study was to test the hypothesis of misdiagnoses for these patients. Patients from the e-PLM centers fulfilling the core clinical criteria for probable AD dementia or mild cognitive impairment due to AD (AD-MCI), with normal CSF A1-42, T-tau and P-tau biomarkers and clinical follow-up, were included. Clinical and imaging data were reviewed by an independent board, from baseline (visit with clinical evaluation and CSF analysis) to the end of the follow-up, for a final diagnosis. In the e-PLM cohort of 1098 AD patients with CSF analysis, 37 (3.3%) patients (20 with AD dementia core clinical criteria and 17 with AD-MCI core clinical criteria) had normal CSF biomarker profile and a clinical follow-up. All patients presented with episodic memory impairment and 27 (73%) had medial temporal lobe atrophy on MRI-scan. After a median follow-up of 36 months (range 7-74), the final diagnosis was AD MCI or dementia for 9 (24%) patients, and unlikely due to AD for 28 (76%) patients. A misdiagnosis was corrected in 18 (49%) patients (mood disorders, non-AD degenerative dementia, vascular cognitive impairment, alcohol cognitive disorders, temporal epilepsy and hippocampal sclerosis), and 10 (27%) patients had cognitive disorders of undetermined etiology. AD diagnosis (MCI or dementia) with normal CSF biomarkers is a rare condition. A clinical follow-up is particularly recommended to consider an alternative diagnosis. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  6. FDG PET/CT criteria for diagnosing mediastinal lymph node metastasis in patients with non-small cell lung cancer

    International Nuclear Information System (INIS)

    Cho, Y. S.; Choi, J. Y.; Lee, K. S.; Kwon, O. J.; Sim, Y. M.; Lee, S. J.; Hyun, S. H.; Lee, J. Y.; Lee, K. H.; Kim, B. T.

    2007-01-01

    We investigated the most accurate FDG PET/CT criteria using various PET and CT parameters for diagnosing metastatic mediastinal lymph nodes in patients with untreated NSCLC. Subjects were 178 consecutive patients with NSCLC undergoing PET/CT and surgical nodal staging. Diagnostic criteria of PET/CT for involvement of each mediastinal nodal station were max. SUV (mSUV), average SUV (aSUV), max. CT Hounsfield unit (mHU), average CT Hounsfield unit (aHU), and 5-point visual grading for CT attenuation; normal, suspicious/definite high attenuation (HA), partial/definite calcification (CAL). ROC curve analysis was done to assess the performance of each PET/CT criterion for detection of metastatic mediastinal nodal station. Of the pathologically examined 649 mediastinal nodal stations, 50 stations in 39 patients were proven to be malignant. The areas under curve (AUC) of ROC analysis for each criteria were 0.8882 (mSUV), 0.8875 (aSUV), 0.5668 (mHU), 0.5468 (aHU), and 0.4369 (VA), respectively. There were no malignant lymph nodes with increased FDG uptake having mHU > 120, aHU > 90, visually definite HA, or CAL. Using the benign criteria of mHU > 120, the AUCs of PET were significantly improved to 0.9233 (mSUV) and 0.9080 (aSUV), respectively (p 90, the AUCs of PET were improved to 0.8991 (mSUV, p 0.05), respectively. Using the benign criteria of visually definite HA or CAL, the AUCs of PET were significantly improved to 0.9094 (mSUV) and 0.9091 (aSUV), respectively (p 120, and visually definite HA or CAL can be used as PET/CT diagnostic criteria suggesting benign mediastinal lymph nodes in patients with NSCLC, irrespective of FDG uptake

  7. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium

    NARCIS (Netherlands)

    Gribble, P.A.; Delahunt, E.; Bleakley, C.M.; Caulfield, B.; Docherty, C.L.; Fong, D.T.; Fourchet, F.; Hertel, J.; Hiller, C.E.; Kaminski, T.W.; McKeon, P.O.; Refshauge, K.M.; Wees, P.J. van der; Vicenzino, W.; Wikstrom, E.A.

    2014-01-01

    While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant or patient selection criteria across studies presents a potential obstacle to addressing the problem

  8. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium

    NARCIS (Netherlands)

    Gribble, P.A.; Delahunt, E.; Bleakley, C.; Caulfield, B.; Docherty, C.; Fourchet, F.; Fong, D.T.; Hertel, J.; Hiller, C.; Kaminski, T.; McKeon, P.; Refshauge, K.; Wees, P.J. van der; Vincenzino, B.; Wikstrom, E.

    2014-01-01

    While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly.

  9. Interobserver agreement of Centers for Disease Control and Prevention criteria for classifying infections in critically ill patients

    NARCIS (Netherlands)

    Klein Klouwenberg, Peter M. C.; Ong, David S. Y.; Bos, Lieuwe D. J.; de Beer, Friso M.; van Hooijdonk, Roosmarijn T. M.; Huson, Mischa A.; Straat, Marleen; van Vught, Lonneke A.; Wieske, Luuk; Horn, Janneke; Schultz, Marcus J.; van der Poll, Tom; Bonten, Marc J. M.; Cremer, Olaf L.

    2013-01-01

    Correct classification of the source of infection is important in observational and interventional studies of sepsis. Centers for Disease Control and Prevention criteria are most commonly used for this purpose, but the robustness of these definitions in critically ill patients is not known. We

  10. The Association Between the STOPP/START Criteria and Gastro-Intestinal Track Bleedings in Elderly Patients

    NARCIS (Netherlands)

    Veldhuis, Anouk; Sent, Danielle; Bruin-Huisman, Linette; Beers, Erna; Abu-Hanna, Ameen

    2017-01-01

    Potentially inappropriate prescribing is a common problem, especially in elderly care. To tackle this problem, Irish medical experts have developed a list of criteria when medication should be added or omitted based upon the patient's physical condition and medication use, known as the STOPP and

  11. Proposal of success criteria for strabismus surgery in patients with Graves' orbitopathy based on a systematic literature review

    NARCIS (Netherlands)

    Jellema, Hinke Marijke; Braaksma-Besselink, Yvette; Limpens, Jacqueline; von Arx, Georg; Wiersinga, Wilmar M.; Mourits, Maarten P.

    2015-01-01

    Proposal of success criteria for strabismus surgery for patients with Graves' orbitopathy (GO) based on a systematic review of the literature. We performed a systematic search of OVID MEDLINE, OVID Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and the publisher subset of

  12. Exclusive radiotherapy and concurrent endocrine therapy for the management of elderly breast cancer patients: Case study and review of hypo-fractionated schemes; Hormonoradiotherapie exclusive dans la prise en charge du cancer du sein de la personne agee: cas clinique et revue de la litterature des schemas hypofractionnes

    Energy Technology Data Exchange (ETDEWEB)

    Auberdiac, P.; Cartier, L.; Malkoun, N.; Chauleur, C.; De Laroche, G.; Magne, N. [Departement de radiotherapie, institut de cancerologie de la Loire, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex (France); Chargari, C. [Service d' oncologie radiotherapie, hopital d' instruction des armees du Val-de-Grace, 74, boulevard de Port-Royal, 75230 Paris cedex 5 (France); Melis, A.; Jacquin, J.P. [Departement d' oncologie medicale, institut de cancerologie de la Loire, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex (France)

    2011-12-15

    Normo-fractionated radiotherapy is standard for adjuvant management of patients treated with breast conservative surgery for breast cancer. However, many elderly patients are not eligible to such strategy, either because of concurrent diseases, or because the tumor is inoperable. Several protocols of exclusive radiotherapy have been reported in the literature, frequently using hypo-fractionated radiotherapy and endocrine therapy. We report a case of a patient treated with exclusive endocrine and radiotherapy and address the state of the art on hypo-fractionated schemes for the management of elderly breast cancer patients. While hypo-fractionated radiotherapy does not compromise the oncologic or cosmetic outcome, there is no prospective data that assesses the place of radiotherapy for the exclusive treatment of elderly patients. This strategy should be further assessed in clinical randomized trial. (authors)

  13. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium.

    Science.gov (United States)

    Gribble, Phillip A; Delahunt, Eamonn; Bleakley, Chris; Caulfield, Brian; Docherty, Carrie; Fourchet, François; Fong, Daniel Tik-Pui; Hertel, Jay; Hiller, Claire; Kaminski, Thomas; McKeon, Patrick; Refshauge, Kathryn; van der Wees, Philip; Vincenzino, Bill; Wikstrom, Erik

    2014-07-01

    While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly. This major gap within the literature limits the ability to generalise this evidence to the target patient population. Therefore, there is a need to provide standards for patient/participant selection criteria in research focused on CAI with justifications using the best available evidence. The International Ankle Consortium provides this position paper to present and discuss an endorsed set of selection criteria for patients with CAI based on the best available evidence to be used in future research and study designs. These recommendations will enhance the validity of research conducted in this clinical population with the end goal of bringing the research evidence to the clinician and patient. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Anatomical criteria of malignancy by computed tomography angiography in patients with anomalous coronary arteries with an interarterial course

    Energy Technology Data Exchange (ETDEWEB)

    Ashrafpoor, Golmehr [Assistance Publique-Hopitaux de Paris, Hopital Europeen Georges Pompidou, Universite Paris Descartes, Department of Radiology, Cardiovascular Imaging Unit, Paris (France); Danchin, Nicolas [Assistance Publique-Hopitaux de Paris, Hopital Europeen Georges Pompidou, Universite Paris Descartes, Department of Cardiology, Paris (France); Houyel, Lucile; Belli, Emre [Centre Chirurgical Marie-Lannelongue, Department of Congenital Cardiac Surgery, Le Plessis-Robinson (France); Ramadan, Ramzi [Centre Chirurgical Marie-Lannelongue, Department of Cardiac Surgery, Le Plessis-Robinson (France); Paul, Jean-Francois [Institut Mutualiste Montsouris, Department of Radiology, Paris (France)

    2014-10-11

    We sought to determine the relation between major adverse cardiac events (MACE) and anatomical criteria assessed by coronary computed tomography angiography (CCTA) in patients with an anomalous coronary artery with an interarterial course (ACAIAC). We selected CCTA studies of patients with an ACAIAC from a database of 4,160 examinations and studied anatomical criteria according to the presence of prior MACE, defined as syncope, unstable angina, myocardial infarction and resuscitated sudden cardiac death. There were 19 patients (18 males) with an ACAIAC during the study period (incidence 0.46 %). Seven patients with prior MACE were younger (26 years vs 59 years, p < 0.001), had a smaller minimal lumen area (3.6 mm{sup 2} vs 9.0 mm{sup 2}, p = 0.001), a higher degree of area stenosis (57 % vs 24 %, p = 0.001), a longer interarterial course (14.7 vs 8.6 mm, p = 0.003) and a smaller proximal segment width (1.6 mm vs 2.5 mm, p = 0.02) compared with the 12 patients without prior MACE. All patients with MACE had the following concomitant anatomical characteristics: minimum lumen area ≤4 mm{sup 2}, an area stenosis ≥50 % and intra-arterial length >10 mm Prior MACE is associated with specific anatomical CCTA characteristics among patients with ACAIAC. CCTA may therefore contribute to distinguish patients at risk of adverse events. (orig.)

  15. Diagnosing ARVC in Pediatric Patients Applying the Revised Task Force Criteria: Importance of Imaging, 12-Lead ECG, and Genetics.

    Science.gov (United States)

    Steinmetz, Michael; Krause, Ulrich; Lauerer, Peter; Konietschke, Frank; Aguayo, Randolph; Ritter, Christian Oliver; Schuster, Andreas; Lotz, Joachim; Paul, Thomas; Staab, Wieland

    2018-05-12

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a potentially lethal disease that is well described in adults. In pediatric patients, however, identification of patients at risk of adverse events of ARVC remains a challenge. We aimed to determine which criteria of the revised Task Force Criteria (rTFC), alone or combined, have an impact on diagnosis of ARVC when compared to disease-specific genetic mutations in pediatric patients ≤ 18 years. Between September 2010 and December 2013, 48 consecutive young patients ≤ 18 years of age (mean 14, range of 12.9-15.1 years) underwent contrast-enhanced magnetic resonance imaging (CMR), genetic testing, and comprehensive clinical work-up for ARVC criteria to test for clinically suspected ARVC. As specified by the rTFC, patients were grouped into four categories: "definite," "borderline," "possible," and "none" ARVC. Of the 48 patients, 12 were found to have gene mutations of either the desmoplakin (9/12) or plakophilin (3/12) locus. According to rTFC 12/48 patients were considered as "definite" ARVC (25%), while 10/12 (83.3%) had an ARVC-specific gene mutation. Of the remaining 36 patients, 6 (12.5%) were grouped as "borderline" ARVC, 7 (14.6%) as "possible" ARVC (including the remaining two genetic mutations), and 22 (45.8%) as "none" ARVC, respectively. Statistical analysis of ARVC criteria in patients diagnosed with "definite" ARVC revealed high prevalence of positive findings by imaging (CMR and echocardiography) and positive genetics. The positive predictive value to detect "definite" ARVC by genotyping was 83.3%, while the negative predictive value was 94%. Logistic regression analyses for different criteria combinations revealed that imaging modalities (echo and CMR combined) and abnormalities of 12-lead ECG were significant markers (p < 0.01). Positive results of endomyocardial biopsies or arrhythmia on ECG or Holter as defined by the rTFC were not significant in this analysis. The rTFC for

  16. Esophageal involvement is frequent in lichen planus: study in 32 patients with suggestion of clinicopathologic diagnostic criteria and therapeutic implications.

    Science.gov (United States)

    Kern, Johannes S; Technau-Hafsi, Kristin; Schwacha, Henning; Kuhlmann, Jan; Hirsch, Gunther; Brass, Volker; Deibert, Peter; Schmitt-Graeff, Anette; Kreisel, Wolfgang

    2016-12-01

    Lichen planus (LP) is a classic skin disease that can involve the skin, hair, and nails, as well as the oral and genital mucosa. Histopathology is characterized by a T-lymphocytic, lichenoid, and interface dermatitis. Multiple case reports and small case series have shown that LP can involve the esophagus. However, the diagnostic criteria, incidence, and best treatment options remain uncertain. This study aimed to refine the diagnostic criteria, estimate prevalence, and present an outlook on treatment options to prevent long-term sequelae. Thirty-two consecutive patients with LP of the skin, hair, nails, oral mucosa, and/or genital mucosa underwent a comprehensive clinicopathologic assessment. Esophagogastroduodenoscopy was performed, and biopsies were evaluated histologically, immunohistochemically, and by direct immunofluorescence. Patients diagnosed with esophageal lichen planus (ELP) were followed up prospectively where possible. In total, 20 of 32 patients had ELP. Ten of these 20 patients were classified as having proven ELP, with clear-cut endoscopically visible lesions; the other 10 were classified as having probable ELP. Eight of 10 patients with proven ELP were started on new or additional therapy because of esophageal findings. Treatment with a topical budesonide formulation or systemic corticosteroids was successful in most patients with proven ELP and reversed functional esophageal stenosis. ELP can be found in more than 50% of patients with proven mucocutaneous LP when clinical and pathologic findings are correlated carefully. Topical or systemic corticosteroids are the first-line therapy for ELP. Timely medical therapy seems to prevent scarring stenosis of the esophagus.

  17. Discussing options between patients and health care professionals in genetic diagnosis: ethical and legal criteria

    Directory of Open Access Journals (Sweden)

    Nicolás Pilar

    2007-09-01

    Full Text Available Abstract The specific characteristics of genetic data lead to ethical-legal conflicts in the framework of genetic diagnosis. Several international organisations, including UNESCO and the Council of Europe, have enacted rules referring to the use of genetic information. This paper discusses possible legal and ethical criteria that could be used in genetic testing.

  18. Criteria-based audit on management of eclampsia patients at a tertiary hospital in Dar es Salaam, Tanzania

    Science.gov (United States)

    Kidanto, Hussein Lesio; Mogren, Ingrid; Massawe, Siriel N; Lindmark, Gunilla; Nystrom, Lennarth

    2009-01-01

    Background Criteria-based audits have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the introduction of a criteria-based audit in a tertiary hospital in an African setting, assesses the quality of care among eclampsia patients and discusses possible interventions in order to improve the quality of care. Methods We conducted a criteria based audit of 389 eclampsia patients admitted to Muhimbili National Hospital (MNH), Dar es Salaam Tanzania between April 14, 2006 and December 31, 2006. Cases were assessed using evidence-based criteria for appropriate care. Results Antepartum, intrapartum and postpartum eclampsia constituted 47%, 41% and 12% of the eclampsia cases respectively. Antepartum eclampsia was mostly (73%) preterm whereas the majority (71%) of postpartum eclampsia cases ware at term. The case fatality rate for eclampsia was 7.7%. Medical histories were incomplete, the majority (75%) of management plans were not reviewed by specialists in obstetrics, specialist doctors live far from the hospital and do not spend nights in hospital even when they are on duty, monitoring of patients on magnesium sulphate was inadequate, and important biochemical tests were not routinely done. Two thirds of the patient scheduled for caesarean section did not undergo surgery within agreed time. Conclusion Potential areas for further improvement in quality of emergency care for eclampsia relate to standardizing management guidelines, greater involvement of specialists in the management of eclampsia and continued medical education on current management of eclampsia for junior staff. PMID:19323846

  19. Criteria-based audit on management of eclampsia patients at a tertiary hospital in Dar es Salaam, Tanzania

    Directory of Open Access Journals (Sweden)

    Lindmark Gunilla

    2009-03-01

    Full Text Available Abstract Background Criteria-based audits have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the introduction of a criteria-based audit in a tertiary hospital in an African setting, assesses the quality of care among eclampsia patients and discusses possible interventions in order to improve the quality of care. Methods We conducted a criteria based audit of 389 eclampsia patients admitted to Muhimbili National Hospital (MNH, Dar es Salaam Tanzania between April 14, 2006 and December 31, 2006. Cases were assessed using evidence-based criteria for appropriate care. Results Antepartum, intrapartum and postpartum eclampsia constituted 47%, 41% and 12% of the eclampsia cases respectively. Antepartum eclampsia was mostly (73% preterm whereas the majority (71% of postpartum eclampsia cases ware at term. The case fatality rate for eclampsia was 7.7%. Medical histories were incomplete, the majority (75% of management plans were not reviewed by specialists in obstetrics, specialist doctors live far from the hospital and do not spend nights in hospital even when they are on duty, monitoring of patients on magnesium sulphate was inadequate, and important biochemical tests were not routinely done. Two thirds of the patient scheduled for caesarean section did not undergo surgery within agreed time. Conclusion Potential areas for further improvement in quality of emergency care for eclampsia relate to standardizing management guidelines, greater involvement of specialists in the management of eclampsia and continued medical education on current management of eclampsia for junior staff.

  20. Patient release criteria following radioactive iodine-131 treatment in the light of international practice: where does South Africa fit in?

    Science.gov (United States)

    Mongane, Modisenyane S; Rae, William I D

    2017-10-01

    The release from hospital of patients treated with radioactive iodine-131 (I) remains a controversial issue as a result of the range of guidelines implemented by national regulatory bodies responsible for radiation protection in various countries worldwide. The aim of this study was to review and analyse the literature on patient release criteria (PRC) applied internationally in an attempt to achieve a justifiable approach to setting equivalent criteria in South Africa. In 2016, the South African Department of Health, Directorate: Radiation Control added conditions (numbers 50 and 90), to licences to use radioactive nuclides. These conditions state that patients must be hospitalized when the dose rate at 1 m is above 25 μSv/h, or more than 555 MBq of iodine-131 was administered to the patient. However, these criteria do not consider patients' socioeconomic conditions. A literature survey was carried out of articles detailing PRC from high-income countries as well as those in the middle-income and lower-income groups. Socioeconomic conditions within countries were determined using the International Monetary Fund lists of gross domestic product. The results from the literature have shown that in setting PRC, several countries have considered the socioeconomic conditions prevailing in their countries to achieve harmony between public protection and cost associated with hospitalization. The South African authority conditions must be seen in the context of the approach followed by other countries. Considering the international context, a justifiable, and potentially implementable, guideline or policy for improving individualized and more caring patient management is advocated.

  1. The Brazilian hazard-based cut-off criteria for pesticide registration: a critical appraisal / Critérios de exclusão baseados em perigo adotados no Brasil para registro de pesticidas: Uma avalição crítica

    Directory of Open Access Journals (Sweden)

    Francisco José Roma Paumgartten

    2013-02-01

    Full Text Available Brazil, the world’s top consumer of agricultural pesticides, adopts a unique hazard-based cut-off approach to pesticide registration. Cut-off criteria for mutagenicity, carcinogenicity, teratogenicity, hormonal disturbances and damage to reproductive organs were introduced by the Pesticide Law enacted in 1989. As far as health is concerned, law enforcement is additionally regulated by rules issued by the federal health authority (National Agency for Health Surveillance – ANVISA. Contrasting to the European Union’s hazard-based cut-off criteria for pesticides, Brazilian rules do not make an exception for “negligible” exposures. Moreover, Brazilian regulations have shortcomings (e.g. no reference to relevance of Mode of Action to humans that make cut-off criteria difficult to be put into effect. The deficiencies of regulations and difficulties to consistently apply the hazard-based cut-off criteria are appraised in this article. Adoption of a risk assessment approach or cut-off criteria based on classification into the Globally Harmonized System’s hazard categories 1A and 1B is suggested. Resumo O Brasil, líder mundial do consumo de agro-químicos, adota uma singular abordagem para registro de agrotóxicos que é baseada em critérios de exclusão quanto à periculosidade. Critérios de exclusão para mutagenicidade, carcinogenicidade, teratogenicidade, distúrbios hormonais e dano a órgãos reprodutivos foram introduzidos pela Lei de Agrotóxicos promulgada em 1989. Em relação à saúde, a aplicação da lei é também regulada por portarias publicadas pela autoridade sanitária federal (Agência Nacional de Vigilância Sanitária – ANVISA. Em contraste com os critérios de exclusão baseados na periculosidade que a União Européia usa para agrotóxicos, a regulamentação brasileira não faz exceção para exposições insignificantes. Além disso, a regulamentação brasileira apresenta deficiências (e.g., não faz men

  2. The DSM-5 effect: psychological characteristics of new patients affected by Binge Eating Disorder following the criteria of the DSM-5 in a sample of severe obese patients.

    Science.gov (United States)

    Vinai, Piergiuseppe; Da Ros, Annalisa; Cardetti, Silvia; Casey, Halpern; Studt, Stacia; Gentile, Nicola; Tagliabue, Anna; Vinai, Luisa; Vinai, Paolo; Bruno, Cecilia; Mansueto, Giovanni; Palmieri, Sara; Speciale, Maurizio

    2016-03-01

    The current study evaluated whether or not there were significant differences in psychopathological traits between three groups of individuals. The first was a group of patients seeking bariatric surgery diagnosed as being affected by Binge Eating Disorder (BED), according to the new criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. This group (NEW BED group) did not meet BED diagnosis following the previous criteria listed in the DSM-IV-TR. The second group of individuals was composed of severely obese patients seeking bariatric surgery not affected by an eating disorder, according to the diagnostic criteria of the DSM-5 (OB group). The third group was composed of individuals within a healthy weight range (Control group). 94 severely obese patients (33 in the NEW BED group and 61 in the OB group) were compared to the Control group including 41 participants on depression, anxiety and eating habits. The NEW BED scored significantly higher than the OB group on the Beck Depression Inventory, both the subscales of the State Trait Anxiety Inventory, on disinhibition and hunger subscales of the Three-Factor Eating Questionnaire and on many subscales of the Eating Disorders Inventory. The new, less restrictive diagnostic criteria for BED of the DSM-5 are useful in identifying obese patients affected by severe psychopathology and dysfunctional eating habits.

  3. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS)

    NARCIS (Netherlands)

    Sieper, J.; Van der Heijde, D.M.; Landewe, RB; Brandt, J.; Burgos-Vagas, R.; Collantes-Estevez, E.; Dijkmans, B.A.C.; Dougados, M.; Khan, M.M.; Leirisalo-Repo, M; van der Linden, S.C.; Maksymowych, W.P.; Mielants, H.; Olivieri, I.; Rudwaleit, M.

    2009-01-01

    Objective: Inflammatory back pain (IBP) is an important clinical symptom in patients with axial spondyloarthritis (SpA), and relevant for classification and diagnosis. In the present report, a new approach for the development of IBP classification criteria is discussed. Methods: Rheumatologists (n =

  4. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS).

    Science.gov (United States)

    Sieper, J; van der Heijde, D; Landewé, R; Brandt, J; Burgos-Vagas, R; Collantes-Estevez, E; Dijkmans, B; Dougados, M; Khan, M A; Leirisalo-Repo, M; van der Linden, S; Maksymowych, W P; Mielants, H; Olivieri, I; Rudwaleit, M

    2009-06-01

    Inflammatory back pain (IBP) is an important clinical symptom in patients with axial spondyloarthritis (SpA), and relevant for classification and diagnosis. In the present report, a new approach for the development of IBP classification criteria is discussed. Rheumatologists (n = 13) who are experts in SpA took part in a 2-day international workshop to investigate 20 patients with back pain and possible SpA. Each expert documented the presence/absence of clinical parameters typical for IBP, and judged whether IBP was considered present or absent based on the received information. This expert judgement was used as the dependent variable in a logistic regression analysis in order to identify those individual IBP parameters that contributed best to a diagnosis of IBP. The new set of IBP criteria was validated in a separate cohort of patients (n = 648). Five parameters best explained IBP according to the experts. These were: (1) improvement with exercise (odds ratio (OR) 23.1); (2) pain at night (OR 20.4); (3) insidious onset (OR 12.7); (4) age at onset validation cohort. This new approach with real patients defines a set of IBP definition criteria using overall expert judgement on IBP as the gold standard. The IBP experts' criteria are robust, easy to apply and have good face validity.

  5. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS)

    NARCIS (Netherlands)

    Sieper, J.; van der Heijde, D.; Landewé, R.; Brandt, J.; Burgos-Vagas, R.; Collantes-Estevez, E.; Dijkmans, B.; Dougados, M.; Khan, M. A.; Leirisalo-Repo, M.; van der Linden, S.; Maksymowych, W. P.; Mielants, H.; Olivieri, I.; Rudwaleit, M.

    2009-01-01

    Inflammatory back pain (IBP) is an important clinical symptom in patients with axial spondyloarthritis (SpA), and relevant for classification and diagnosis. In the present report, a new approach for the development of IBP classification criteria is discussed. Rheumatologists (n = 13) who are experts

  6. Evaluation Criteria of Noninvasive Telemonitoring for Patients With Heart Failure: Systematic Review.

    Science.gov (United States)

    Farnia, Troskah; Jaulent, Marie-Christine; Steichen, Olivier

    2018-01-16

    Telemonitoring can improve heart failure (HF) management, but there is no standardized evaluation framework to comprehensively evaluate its impact. Our objectives were to list the criteria used in published evaluations of noninvasive HF telemonitoring projects, describe how they are used in the evaluation studies, and organize them into a consistent scheme. Articles published from January 1990 to August 2015 were obtained through MEDLINE, Web of Science, and EMBASE. Articles were eligible if they were original reports of a noninvasive HF telemonitoring evaluation study in the English language. Studies of implantable telemonitoring devices were excluded. Each selected article was screened to extract the description of the telemonitoring project and the evaluation process and criteria. A qualitative synthesis was performed. We identified and reviewed 128 articles leading to 52 evaluation criteria classified into 6 dimensions: clinical, economic, user perspective, educational, organizational, and technical. The clinical and economic impacts were evaluated in more than 70% of studies, whereas the educational, organizational, and technical impacts were studied in fewer than 15%. User perspective was the most frequently covered dimension in the development phase of telemonitoring projects, whereas clinical and economic impacts were the focus of later phases. Telemonitoring evaluation frameworks should cover all 6 dimensions appropriately distributed along the telemonitoring project lifecycle. Our next goal is to build such a comprehensive evaluation framework for telemonitoring and test it on an ongoing noninvasive HF telemonitoring project. ©Troskah Farnia, Marie-Christine Jaulent, Olivier Steichen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 16.01.2018.

  7. Allergic bronchopulmonary aspergillosis in Italian cystic fibrosis patients: Prevalence and percentage of positive tests in the employed diagnostic criteria

    International Nuclear Information System (INIS)

    Taccetti, Giovanni; Procopio, Elena; Marianelli, Lore; Campana, Silvia

    2000-01-01

    The prevalence of allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients is difficult to determine because the data in the literature are not homogeneous or comparable. ABPA and CF have similar clinical symptoms which make diagnosis difficult and underestimate the real dimensions of the problem. We conducted an epidemiological study on 3089 Italian CF patients to determine the prevalence of ABPA in Italy and verify the percentage of positive tests in the employed diagnostic criteria. Our results indicate that the prevalence of ABPA in Italian CF patients is 6.18%, mainly in adolescents and young adults. ABPA is diagnosed using clinical symptoms (presence of episodic bronchial obstructions or typical radiographic features) and on the basis of other criteria which can only be partially fulfilled in paediatric patients. Among the diagnostic tests the most sensitive are the total IgE (84.5%), specific IgE anti-Aspergillus fumigatus (81.6%) and the prick test (68.3%). In the absence of clinical symptoms and gold standard diagnostic tests, serological positivity and/or the skin test are not sufficient evidence to confirm the presence of ABPA

  8. Hard exclusive QCD processes

    Energy Technology Data Exchange (ETDEWEB)

    Kugler, W.

    2007-01-15

    Hard exclusive processes in high energy electron proton scattering offer the opportunity to get access to a new generation of parton distributions, the so-called generalized parton distributions (GPDs). This functions provide more detailed informations about the structure of the nucleon than the usual PDFs obtained from DIS. In this work we present a detailed analysis of exclusive processes, especially of hard exclusive meson production. We investigated the influence of exclusive produced mesons on the semi-inclusive production of mesons at fixed target experiments like HERMES. Further we give a detailed analysis of higher order corrections (NLO) for the exclusive production of mesons in a very broad range of kinematics. (orig.)

  9. Prevalence of the metabolic syndrome in patients with carotid disease according to NHLBI/AHA and IDF criteria: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Maksimovic Milos Z

    2012-01-01

    Full Text Available Abstract Background Metabolic syndrome (MetS has been related to type 2 diabetes and cardiovascular diseases. Different criteria for diagnosis of MetS have been recommended, but there is no agreement about which criteria are best to use. The aim of the present study was to investigate agreement between the National Heart, Lung, and Blood Institute, American Heart Association (NHLBI/AHA and the International Diabetes Federation (IDF definitions of MetS in patients with symptomatic carotid disease and to compare the frequency of cardiovascular risk factor in patients with MetS diagnosed by these two sets of criteria. Methods The study was a cross-sectional one involving 644 consecutive patients with verified carotid disease who referred to the Vascular Surgery Clinic Dedinje in Belgrade during the period April 2006 - November 2007. Anthropometric parameters blood pressure, fasting plasma glucose and lipoproteins were measured using standard procedures. Results MetS was present in 67.9% of participants, according to IDF criteria, and in 64.9% of participants, according to the NHLBI/AHA criteria. A total of 119 patients were categorized differently by the two definitions. Out of all participants 10.7% had MetS by IDF criteria only and 7.8% of patients had MetS by NHLBI/AHA criteria only. The overall agreement of IDF and NHLBI/AHA criteria was 81.5% (Kappa 0.59, p Conclusion The MetS prevalence in patients with symptomatic carotid disease was high regardless of criteria used for its diagnosis. Since some patients with known cardiovascular risk factors were lost by the use of IDF criteria it seems that NHLBI/AHA definition is more suitable for diagnosis of MetS. Large follow-up studies are needed to test prognostic value of these definitions.

  10. Criteria for the selective use of chest computed tomography in blunt trauma patients.

    NARCIS (Netherlands)

    Brink, M.; Deunk, J.; Dekker, H.M.; Edwards, M.J.R.; Kool, D.R.; Vugt, A.B. van; Kuijk, C. van; Blickman, J.G.

    2010-01-01

    PURPOSE: The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. METHODS: This observational study prospectively included consecutive patients (>or=16 years old) who underwent

  11. Stigma, social reciprocity and exclusion of HIV/AIDS patients with illicit drug histories: A study of Thai nurses' attitudes

    Directory of Open Access Journals (Sweden)

    Stoové Mark A

    2008-08-01

    Full Text Available Abstract Background Stigma is a key barrier for the delivery of care to patients living with HIV/AIDS (PLWHA. In the Asia region, the HIV/AIDS epidemic has disproportionately affected socially marginalised groups, in particular, injecting drug users. The effect of the stigmatising attitudes towards injecting drug users on perceptions of PLWHA within the health care contexts has not been thoroughly explored, and typically neglected in terms of stigma intervention. Methods Semi-structured interviews were conducted with a group of twenty Thai trainee and qualified nurses. Drawing upon the idea of 'social reciprocity', this paper examines the constructions of injecting drug users and PLWHA by a group of Thai nurses. Narratives were explored with a focus on how participants' views concerning the high-risk behaviour of injecting drug use might influence their attitudes towards PLWHA. Results The analysis shows that active efforts were made by participants to separate their views of patients living with HIV/AIDS from injecting drug users. While the former were depicted as patients worthy of social support and inclusion, the latter were excluded on the basis that they were perceived as irresponsible 'social cheaters' who pose severe social and economic harm to the community. Absent in the narratives were references to wider socio-political and epidemiological factors related to drug use and needle sharing that expose injecting drug users to risk; these behaviours were constructed as individual choices, allowing HIV positive drug users to be blamed for their seropositive status. These attitudes could potentially have indirect negative implications on the nurses' opinions of patients living with HIV/AIDS more generally. Conclusion Decreasing the stigma associated with illicit drugs might play crucial role in improving attitudes towards patients living with HIV/AIDS. Providing health workers with a broader understanding of risk behaviours and redirecting

  12. Criteria for the selective use of chest computed tomography in blunt trauma patients

    Energy Technology Data Exchange (ETDEWEB)

    Brink, Monique; Dekker, Helena M.; Kool, Digna R.; Blickman, Johan G. [Radboud University Nijmegen, Medical Centre, Department of Radiology, Nijmegen (Netherlands); Deunk, Jaap; Edwards, Michael J.R. [Radboud University Nijmegen, Medical Centre, Department of Surgery, Nijmegen (Netherlands); Vugt, Arie B. van [Radboud University Nijmegen, Medical Centre Nijmegen, Department of Emergency Medicine, Nijmegen (Netherlands); Kuijk, Cornelis van [VU (Vrije Universiteit) University, Medical Center Amsterdam, Department of Radiology, Amsterdam (Netherlands)

    2010-04-15

    The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. This observational study prospectively included consecutive patients ({>=}16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre. We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT. Using logistic regression, we identified nine predictors of chest injury presence on CT (age {>=}55 years, abnormal chest physical examination, altered sensorium, abnormal thoracic spine physical examination, abnormal chest conventional radiography (CR), abnormal thoracic spine CR, abnormal pelvic CR or abdominal ultrasound, base excess <-3 mmol/l and haemoglobin <6 mmol/l). Of 855 patients with {>=}1 positive predictors, 484 had injury on CT (95% of all 508 patients with injury). Of all 192 patients with no positive predictor, 24 (13%) had chest injury, of whom 4 (2%) had injuries that were considered clinically relevant. Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected. (orig.)

  13. Criteria for the selective use of chest computed tomography in blunt trauma patients

    International Nuclear Information System (INIS)

    Brink, Monique; Dekker, Helena M.; Kool, Digna R.; Blickman, Johan G.; Deunk, Jaap; Edwards, Michael J.R.; Vugt, Arie B. van; Kuijk, Cornelis van

    2010-01-01

    The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. This observational study prospectively included consecutive patients (≥16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre. We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT. Using logistic regression, we identified nine predictors of chest injury presence on CT (age ≥55 years, abnormal chest physical examination, altered sensorium, abnormal thoracic spine physical examination, abnormal chest conventional radiography (CR), abnormal thoracic spine CR, abnormal pelvic CR or abdominal ultrasound, base excess <-3 mmol/l and haemoglobin <6 mmol/l). Of 855 patients with ≥1 positive predictors, 484 had injury on CT (95% of all 508 patients with injury). Of all 192 patients with no positive predictor, 24 (13%) had chest injury, of whom 4 (2%) had injuries that were considered clinically relevant. Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected. (orig.)

  14. Improvement of decision-making criteria for the care of elderly cancer patients by general practitioners (Lorraine, France

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    Niemier JY

    2018-05-01

    Full Text Available Jean-Yves Niemier,1,2 Frédérique Claudot,3,4 Phi Linh Nguyen-Thi,4 Jean-Marie Hubert,5 Hubert Rousselot,2,6 Athanase Benetos,1 Christine Perret-Guillaume1,3 1Department of Geriatric Medicine, CHRU de Nancy, Nancy, France; 2UCOG Lorraine, Nancy, France; 3EA 4360 APEMAC, Faculté de Médecine, Université de Lorraine, Nancy, France; 4PARC, CHRU de Nancy, Nancy, France; 5Spincourt Multidisciplinary MSP, Spincourt, France; 6SISSPO Department, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France Objective: The objective of this study was to identify changes in the decision-making criteria of general practitioners (GPs concerning the care of elderly cancer patients after 1 year of corrective measures for care practices in the Lorraine region, France. Materials and methods: In 2014, a postal mail questionnaire was sent to all GPs in the Lorraine region. This questionnaire was designed to identify GPs’ decision-making criteria. It was based on the results of a literature review and on existing guidelines. During 1 year, corrective measures were implemented to improve practices, especially training sessions for physicians and production of specific tools, including a guide to the accepted ideas in geriatric oncology. In 2015, the same questionnaire was resent to all GPs to compare the answers. Results: In 2014, 430 questionnaires were returned out of 2,048 sent, and in 2015, 378 questionnaires were returned out of 2,066 sent. Our results show for the first time that there exists a significant difference in the overall decision criteria between the two survey periods. This difference mainly concerns criteria related to the cancerous diseases. Physicians tend to consider the principal decision criteria to be less important after the training period. GPs express the importance of accessibility to specialists for additional advice in both 2014 and 2015; the distance between the patient’s home and an adapted care facility and the

  15. Comparison of EORTC criteria and PERCIST for PET/CT response evaluation of patients with metastatic colorectal cancer treated with irinotecan and cetuximab

    DEFF Research Database (Denmark)

    Skougaard, Kristin; Nielsen, Dorte; Jensen, Benny Vittrup

    2013-01-01

    The study aim was to compare European Organization for Research and Treatment of Cancer (EORTC) criteria with PET Response Criteria in Solid Tumors (PERCIST) for response evaluation of patients with metastatic colorectal cancer treated with a combination of the chemotherapeutic drug irinotecan an...... and the monoclonal antibody cetuximab....

  16. Use of complementary and alternative medicine among patients: classification criteria determine level of use.

    Science.gov (United States)

    Kristoffersen, Agnete Egilsdatter; Fønnebø, Vinjar; Norheim, Arne Johan

    2008-10-01

    Self-reported use of complementary and alternative medicine (CAM) among patients varies widely between studies, possibly because the definition of a CAM user is not comparable. This makes it difficult to compare studies. The aim of this study is to present a six-level model for classifying patients' reported exposure to CAM. Prayer, physical exercise, special diets, over-the-counter products/CAM techniques, and personal visits to a CAM practitioner are successively removed from the model in a reductive fashion. By applying the model to responses given by Norwegian patients with cancer, we found that 72% use CAM if the user was defined to include all types of CAM. This proportion was reduced successively to only 11% in the same patient group when a CAM user was defined as a user visiting a CAM practitioner four or more times. When considering a sample of 10 recently published studies of CAM use among patients with breast cancer, we found 98% use when the CAM user was defined to include all sorts of CAM. This proportion was reduced successively to only 20% when a CAM user was defined as a user of a CAM practitioner. We recommend future surveys of CAM use to report at more than one level and to clarify which intensity level of CAM use the report is based on.

  17. Exclusive Dealing and Entry

    OpenAIRE

    João Leão

    2008-01-01

    This paper examines the use of exclusive dealing agreements to prevent the entry of rival firms. An exclusive dealing agreement is a contract between a buyer and a seller where the buyer commits to buy a good exclusively from the seller. One main concern of the literature is to explain how an incumbent seller is able to persuade the buyers to sign an exclusive dealing agreement that deters the entry of a more efficient rival seller. We propose a new explanation when the buyers are downstream ...

  18. [Influence of distinct criteria for selecting patients for swabbing on estimation of the effectiveness of the influenza vaccine].

    Science.gov (United States)

    Martínez-Baz, Iván; Guevara, Marcela; Elía, Fernando; Ezpeleta, Carmen; Fernández Alonso, Mirian; Castilla, Jesús

    2014-01-01

    To estimate the effectiveness of the influenza vaccine under different criteria for selecting patients for swabbing. A case-control study was performed of laboratory-confirmed cases (n=909) and negative controls for influenza (n=732) in the 2010-2011 to 2012-2013 seasons in Navarre (Spain). The adjusted vaccine effectiveness was estimated by including all swabs from patients with influenza-like-illness and selecting only the first two cases per physician and week. The first two patients per physician and week were less frequently vaccinated against influenza (7.9% vs. 12.5%, p=0.021) and less often received confirmation of influenza (53.6% vs. 66.4%, p <0.001) than subsequent patients. These differences decreased after adjustment for covariates. The effectiveness of the influenza vaccine was 49% (95% CI: 23-66%) when all swabs were included and was 55% (95% CI: 27-72%) when we selected the first two swabs per week and physician. The selection of the first two patients per physician and week may bias assessment of the effectiveness of the influenza vaccine, although this bias was small in the seasons analyzed. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  19. Complete response in a patient with gynecological hidradenocarcinoma treated with exclusive external beam radiotherapy and brachytherapy: a case report.

    Science.gov (United States)

    Giannelli, Flavio; Chiola, Ilaria; Belgioia, Liliana; Garelli, Stefania; Pastorino, Alice; Marcenaro, Michela; Mammoliti, Serafina; Costantini, Sergio; Bizzarri, Nicolò; Vellone, Valerio; Barra, Salvina; Corvò, Renzo

    2017-12-01

    Hidradenocarcinoma (HC) is a very rare disease. This case report illustrates a successful treatment of a 60-year-old woman with vulvo-vaginal localization of hidradenocarcinoma treated with external beam radiotherapy delivered by helical tomotherapy with a simultaneous integrated boost (SIB), followed by brachytherapy. External beam radiotherapy dose prescription was 50.4 Gy in 28 fractions, five fractions per week to whole pelvis (planning target volume 1 - PTV1), 60.2 Gy in 28 fractions to SIB1 (fundus of uterus and right inguinal node), and 58.8 Gy in 28 fractions to SIB2 (lower/middle third of vagina, paraurethral region and right inguinal lymph nodes). Brachytherapy dose prescription was 28 Gy in 4 fractions for cervix, fundus of uterus and upper third of vagina (HR-CTV1), and 22 Gy in 4 fractions to middle third of vagina and paraurethral region (HR-CTV2). D 90 for whole treatment was 91.9 Gy and 86.0 Gy for HR-CTV1 and HR-CTV2, respectively. Patient remained 12-months disease-free without treatment related side effects.

  20. Complete response in a patient with gynecological hidradenocarcinoma treated with exclusive external beam radiotherapy and brachytherapy: a case report

    Directory of Open Access Journals (Sweden)

    Flavio Giannelli

    2017-12-01

    Full Text Available Hidradenocarcinoma (HC is a very rare disease. This case report illustrates a successful treatment of a 60-year-old woman with vulvo-vaginal localization of hidradenocarcinoma treated with external beam radiotherapy delivered by helical tomotherapy with a simultaneous integrated boost (SIB, followed by brachytherapy. External beam radiotherapy dose prescription was 50.4 Gy in 28 fractions, five fractions per week to whole pelvis (planning target volume 1 – PTV1, 60.2 Gy in 28 fractions to SIB1 (fundus of uterus and right inguinal node, and 58.8 Gy in 28 fractions to SIB2 (lower/middle third of vagina, paraurethral region and right inguinal lymph nodes. Brachytherapy dose prescription was 28 Gy in 4 fractions for cervix, fundus of uterus and upper third of vagina (HR-CTV1, and 22 Gy in 4 fractions to middle third of vagina and paraurethral region (HR-CTV2. D90 for whole treatment was 91.9 Gy and 86.0 Gy for HR-CTV1 and HR-CTV2, respectively. Patient remained 12-months disease-free without treatment related side effects.

  1. New Criteria of Indication and Selection of Patients to Cochlear Implant

    Directory of Open Access Journals (Sweden)

    André L. L. Sampaio

    2011-01-01

    Full Text Available Numerous changes continue to occur in cochlear implant candidacy. In general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Together, this has advanced the utility and safety of cochlear implantation. Most devices are now approved for use in patients with severe to profound unilateral hearing loss rather then the prior requirement of a bilateral profound loss. Furthermore, studies have begun utilizing short electrode arrays for shallow insertion in patients with considerable low-frequency residual hearing. This technique will allow the recipient to continue to use acoustically amplified hearing for the low frequencies simultaneously with a cochlear implant for the high frequencies. The advances in design of, and indications for, cochlear implants have been matched by improvements in surgical techniques and decrease in complications. The resulting improvements in safety and efficacy have further encouraged the use of these devices. This paper will review the new concepts in the candidacy of cochlear implant. Medline data base was used to search articles dealing with the following topics: cochlear implant in younger children, cochlear implant and hearing preservation, cochlear implant for unilateral deafness and tinnitus, genetic hearing loss and cochlear implant, bilateral cochlear implant, neuropathy and cochlear implant and neural plasticity, and the selection of patients for cochlear implant.

  2. Implementation of exclusive truck facilities

    Energy Technology Data Exchange (ETDEWEB)

    Fekpe, E. [Battelle Memorial Inst., Columbus, OH (United States). Transportation Market Sector

    2007-07-01

    This paper discussed the issue of highway congestion, safety, and efficiency in freight movement on highways, with particular reference to the challenge of supporting increasing capacity demand from truck traffic. Innovative and practical solutions are needed to address the growing need for more efficient freight movement while maintaining acceptable levels of safety on highways. The concept of exclusive truck facilities (ETFs) is becoming an attractive option as a feasible strategy to help stabilize traffic flow, reduce congestion, improve safety, enhance transportation system management, improve access to freight facilities, and improve efficiency in freight movement along corridors of national importance. ETFs can either be truck only lanes or truckways. Passenger cars may not use ETFs. However, the use of ETFs could involve high costs of construction, maintenance, and acquisition of additional right of way. A cost-benefit analysis was performed for alternative ETF configurations under different traffic and site characteristics. A set of criteria was then proposed for identifying suitable locations for exclusive truck lanes. It was proposed that ETFs are economically feasible at locations with traffic volume of 100,000 vehicles per day or more and with a truck volume of at least 25 per cent of the traffic. In addition, the rate of truck-involved fatal crashes and level of service should be used to prioritize preliminary candidate locations that satisfy the traffic criteria. Consideration should also be given to the existence of freight terminals, ports, processing centers or regional distribution centres that are close to highways. 11 refs., 1 tab.

  3. Are All Mutations the Same? A Rare Case Report of Coexisting Mutually Exclusive KRAS and BRAF Mutations in a Patient with Metastatic Colon Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Anusha Vittal

    2017-01-01

    Full Text Available 29-year-old Hispanic woman presented to the clinic with complaints of abdominal pain, nausea, fatigue, and constipation. Laboratory tests indicated the presence of iron deficiency anemia and transaminitis. Imaging evaluation revealed marked hepatomegaly with multiple hepatic metastases and pelvic lymphadenopathy. Biopsy of the hepatic lesions showed adenocarcinoma positive for pan-cytokeratin, CMA5.2, villin, and CDX2. She was positive for tumor markers CA 19-9, CA-125, and CEA. Upon further evaluation, she was found to have colorectal cancer positive for KRAS and BRAF mutations. Unfortunately, her disease progressed rapidly and she expired within 3 months from the time of her first diagnosis. KRAS and BRAF mutations are rare enough to be considered virtually mutually exclusive but coexistent mutations appear to be a distinct molecular and clinical subset with aggressive course of illness, which is in dire need of new treatment strategies. Panitumumab and Cetuximab are approved for patients with wild type KRAS CRC. Vemurafenib is a potent inhibitor of the kinase domain in mutant BRAF and its use in BRAF mutated colon cancer remains to be well established. Our report highlights the need to obtain tissue samples from these patients for analysis and to evaluate the benefit of Vemurafenib in colorectal cancers.

  4. Will the right Robin patient rise, please? Definitions and criteria during management of Robin sequence patients in the Netherlands and Belgium.

    Science.gov (United States)

    Basart, Hanneke; Kruisinga, Frea H; Breugem, Corstiaan C; Don Griot, J Peter W; Hennekam, Raoul C; Van der Horst, Chantal M A M

    2015-01-01

    Robin Sequence (RS) is characterized by micrognathia and upper airway obstruction (UAO), with or without cleft palate, causing respiratory and feeding problems. Management options are: positioning; nasopharyngeal airway (NPA); tongue-lip adhesion (TLA); mandibular distraction (MDO); and tracheostomy. Controversy exists in literature regarding RS definition and management. Here we describe definitions, management strategies and criteria in opting for management strategies, used by Dutch and Belgian cleft teams. A specifically designed questionnaire was sent to members of all 16 Dutch and Belgian cleft teams. 14 cleft teams returned 35 questionnaires. All used micrognathia as definition criterion, 93.4% cleft palate, 51.5%glossoptosis and 45.7% UAO. Six different RS definitions were used; even within a single team >1 definition was used. All teams used different management strategies: all used positioning, 10 NPA, 6 TLA, 7 MDO, 8 tracheostomy, 5 refer patients with invasive treatment indication. Criteria in opting management modalities were: O2-saturation (89.3%), clinical presentation (86.2%), growth and feeding problems (69.0%), polysomnography (62.1%), and differed within teams. The Dutch and Belgian cleft teams use variable RS definitions, different management modalities and criteria in choosing management strategies. A single, strict definition and evidence-based management guidelines should be formulated for optimal patient care. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  5. Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement.

    Science.gov (United States)

    Tavakoli, Reza; Leprince, Pascal; Gassmann, Max; Jamshidi, Peiman; Yamani, Nassrin; Amour, Julien; Lebreton, Guillaume

    2018-03-26

    Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The incidence of the pathology increases with growing age after 65 years. Conventional surgical aortic valve replacement through median sternotomy has been the gold standard of patient care for symptomatic aortic valve stenosis. However, as the risk profile of patients worsens, other therapeutic strategies have been introduced in an attempt to maintain the excellent results obtained by the established surgical treatment. One of these approaches is represented by transcatheter aortic valve implantation. Although the outcomes of high-risk patients undergoing treatment for symptomatic aortic valve stenosis have improved with transcatheter aortic valve replacement, many patients with this condition remain candidates for surgical aortic valve replacement. In order to reduce the surgical trauma in patients who are candidates for surgical aortic valve replacement, minimally invasive approaches have garnered interest during the past decade. Since the introduction of right anterior thoracotomy for aortic valve replacement in 1993, right anterior mini-thoracotomy and upper hemi-sternotomy have become the predominant incisional approaches among cardiac surgeons performing minimal access aortic valve replacement. Beside the location of the incision, the arterial cannulation site represents the second major landmark of minimal access techniques for aortic valve replacement. The two most frequently used arterial cannulation sites include central aortic and peripheral femoral approaches. With the purpose of reducing surgical trauma in these patients, we have opted for a right anterior mini-thoracotomy approach with a central aortic cannulation site. This protocol describes in detail a technique for minimally invasive aortic valve replacement and provides recommendations for patient selection criteria, including cardiac computer

  6. TLG-S criteria are superior to both EORTC and PERCIST for predicting outcomes in patients with metastatic lung adenocarcinoma treated with erlotinib

    Energy Technology Data Exchange (ETDEWEB)

    Ho, Kung-Chu [National Taiwan University, Graduate Institute of Biomedical Electronics and Bioinformatics, Taipei (China); Chang Gung Memorial Hospital and Chang Gung University, Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Taoyuan (China); Fang, Yu-Hua Dean [National Cheng Kung University, Department of Biomedical Engineering, Tainan (China); Chung, Hsiao-Wen [National Taiwan University, Graduate Institute of Biomedical Electronics and Bioinformatics, Taipei (China); Liu, Yuan-Chang [Chang Gung Memorial Hospital and Chang Gung University, Department of Medical Imaging and Intervention, Taoyuan (China); Chang, John Wen-Cheng; Hou, Ming-Mo [Chang Gung Memorial Hospital and Chang Gung University, Division of Hematology-Oncology, Department of Internal Medicine, Taoyuan (China); Yang, Cheng-Ta [Chang Gung Memorial Hospital and Chang Gung University, Department of Thoracic Medicine, Taoyuan (China); Cheng, Nai-Ming; Yen, Tzu-Chen [Chang Gung Memorial Hospital and Chang Gung University, Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Taoyuan (China); Su, Tzu-Pei [Chang Gung Memorial Hospital, Department of Nuclear Medicine, Keelung (China)

    2016-11-15

    In this retrospective review of prospectively collected data, we sought to investigate whether early FDG-PET assessment of treatment response based on total lesion glycolysis measured using a systemic approach (TLG-S) would be superior to either local assessment with EORTC (European Organization for Research and Treatment of Cancer) criteria or single-lesion assessment with PERCIST (PET Response Criteria in Solid Tumors) for predicting clinical outcomes in patients with metastatic lung adenocarcinoma treated with erlotinib. We also examined the effect of bone flares on tumor response evaluation by single-lesion assessment with PERCIST in patients with metastatic bone lesions. We performed a retrospective review of prospectively collected data from 23 patients with metastatic lung adenocarcinoma treated with erlotinib. All participants underwent FDG-PET imaging at baseline and on days 14 and 56 after completion of erlotinib treatment. In addition, diagnostic CT scans were performed at baseline and on day 56. FDG-PET response was assessed with TLG-S, EORTC, and PERCIST criteria. Response assessment based on RECIST 1.1 (Response Evaluation Criteria in Solid Tumors) from diagnostic CT imaging was used as the reference standard. Two-year progression-free survival (PFS) and overall survival (OS) served as the main outcome measures. We identified 13 patients with bone metastases. Of these, four (31 %) with persistent bone uptake due to bone flares on day 14 were erroneously classified as non-responders according to the PERCIST criteria, but they were correctly classified as responders according to both the EORTC and TLG-S criteria. Patients who were classified as responders on day 14 based on TLG-S criteria had higher rates of 2-year PFS (26.7 % vs. 0 %, P = 0.007) and OS (40.0 % vs. 7.7 %, P = 0.018). Similar rates were observed in patients who showed a response on day 56 based on CT imaging according to the RECIST criteria. Patients classified as responders on day 14

  7. Impact of UCSF criteria according to pre- and post-OLT tumor features: analysis of 479 patients listed for HCC with a short waiting time.

    Science.gov (United States)

    Decaens, Thomas; Roudot-Thoraval, Françoise; Hadni-Bresson, Solange; Meyer, Carole; Gugenheim, Jean; Durand, Francois; Bernard, Pierre-Henri; Boillot, Olivier; Sulpice, Laurent; Calmus, Yvon; Hardwigsen, Jean; Ducerf, Christian; Pageaux, Georges-Philippe; Dharancy, Sebastien; Chazouilleres, Olivier; Cherqui, Daniel; Duvoux, Christophe

    2006-12-01

    Orthotopic liver transplantation (OLT) indication for hepatocellular carcinoma (HCC) is currently based on the Milan criteria. The University of California, San Francisco (UCSF) recently proposed an expansion of the selection criteria according to tumors characteristics on the explanted liver. This study: 1) assessed the validity of these criteria in an independent large series and 2) tested for the usefulness of these criteria when applied to pre-OLT tumor evaluation. Between 1985 and 1998, 479 patients were listed for liver transplantation (LT) for HCC and 467 were transplanted. According to pre-OLT (imaging at date of listing) or post-OLT (explanted liver) tumor characteristics, patients were retrospectively classified according to both the Milan and UCSF criteria. The 5-yr survival statistics were assessed by the Kaplan-Meier method and compared by the log-rank test. Pre-OLT UCSF criteria were analyzed according to an intention-to-treat principle. Based on the pre-OLT evaluation, 279 patients were Milan+, 44 patients were UCSF+ but Milan- (subgroup of patients that might benefit from the expansion), and 145 patients were UCSF- and Milan-. With a short median waiting time of 4 months, 5-yr survival was 60.1 +/- 3.0%, 45.6 +/- 7.8%, and 34.7 +/- 4.0%, respectively (P OLT evaluation, the UCSF criteria are associated with a 5-yr survival below 50%. Their applicability is therefore limited, despite similar survival rates compared to the Milan criteria, when the explanted liver is taken into account.

  8. The influence of various anesthesia techniques on postoperative recovery and discharge criteria among geriatric patients

    Directory of Open Access Journals (Sweden)

    Dilsen Ornek

    2010-01-01

    Full Text Available OBJECTIVE: We aim to compare selective spinal anesthesia and general anesthesia with regard to postoperative recovery and fast-track eligibility in day surgeries. MATERIALS AND METHOD: Sixty geriatric outpatient cases, with ASA II-III physical status and requiring shortduration transurethral intervention, were enrolled in the study. The cases were split into 2 groups: as general anesthesia (Group GA and selective spinal anesthesia (Group SSA. Group GA (n = 30 received propofol 2 mg kg-1 (until loss of eyelash reflex, remifentanil induction 0.5-1 µg kg-1, and laryngeal mask. Maintenance was achieved by 4-6% desflurane in 60% N2O and 40% O2 along with remifentanil infusion at 0.05 µg /kg-1 /min-1. Drugs were discontinued after the withdrawal of the ureteroscope, and extubation was carried out with 100% O2. Group SSA (n = 30 received 0.5% spinal anesthesia via L4-5 space by 0.5% hyperbaric bupivacaine 5 mg. Anesthesia preparation time, time to surgical anesthesia level, postoperative fast-tracking, and time to White-Song recovery score of 12, were noted. In the operating room, we evaluated hemodynamics, nausea/vomiting, surgeon and patient satisfaction with anesthesia, perioperative midazolam-fentanyl administration, postoperative pain, and discharge time. RESULTS: Anesthesia preparation time, length of surgery, anesthesia-related time in the operating room, time to sit, and time to walk were significantly low in Group GA (p < 0.05, whereas time to fast-track eligibility, length of stay in the PACU, discharge time, and other parameters were similar in both of the groups. CONCLUSION: While anesthesia preparation time, length of surgery, start time of surgery, time to sit, and time to walk were shorter in the General Anesthesia group, time to fast-track eligibility, phase 1 recovery time, and discharge time were similar among patients subjected to selective spinal anesthesia.

  9. Optimisation of metabolic criteria in the prognostic assessment in patients with lymphoma. A multicentre study.

    Science.gov (United States)

    Del Puig Cózar-Santiago, M; García-Garzón, J R; Moragas-Freixa, M; Soler-Peter, M; Bassa Massanas, P; Sánchez-Delgado, M; Sanchez-Jurado, R; Aguilar-Barrios, J E; Sanz-Llorens, R; Ferrer-Rebolleda, J

    To compare sensitivity, specificity and predictive value of Deauville score (DS) vs. ΔSUVmax in interim-treatment PET (iPET) and end-treatment PET (ePET), in patients with diffuse large B cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and follicular lymphoma (FL). Retrospective longitudinal multicentre study including 138 patients (46 DLBCL, 46 HL, 46 FL), on whom 3 18 F-FDG PET/CT were performed: baseline, iPET, and ePET. Visual (DS) and semi-quantitative (ΔSUVmax) parameters were determined for iPET and ePET. Predictive value was determined in relation to disease-free interval. Statistical analysis. iPET for DLBCL, HL, and FL: 1) sensitivity of DS: 76.92/83.33/61.53%; specificity: 78.78/85/81.81%; 2) sensitivity of ΔSUVmax: 53.84/83.33/61.53%; specificity: 87.87/87.50/78.78%. ePET for DLBCL, HL and FL: 1) sensitivity of DS: 61.53/83.33/69.23%; specificity: 90.90/85/87.87%; 2) sensitivity of ΔSUVmax: 69.23/83.33/69.23%; specificity: 90.90/87.50/84.84%. Predictive assessment. iPET study: in DLBCL, DS resulted in 10.3% recurrence of negative iPET, and 17.1% in ΔSUVmax at disease-free interval; in HL, both parameters showed a 2.8% recurrence of negative iPET; in FL, DS resulted in 15.6% recurrence of negative iPET, and 16.1% in ΔSUVmax, with no statistical significance. ePET study: in DLBCL, DS resulted in 14.3% recurrence of negative ePET, and 11.8% in ΔSUVmax at disease-free interval; in HL and FL, both methods showed 2.8 and 12.5% recurrence in negative ePET, respectively. DS and ΔSUVmax did not show significant differences in DLBCL, HL and FL. Their predictive value also did not show significant differences in HL and FL. In DLBCL, DS was higher in iPET, and ΔSUVmax in ePET. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  10. Prevalence of elevated serum anti-N-methyl-D-aspartate receptor antibody titers in patients presenting exclusively with psychiatric symptoms: a comparative follow-up study.

    Science.gov (United States)

    Ando, Yoshihito; Shimazaki, Haruo; Shiota, Katsutoshi; Tetsuka, Syuichi; Nakao, Koichi; Shimada, Tatsuhiro; Kurata, Kazumi; Kuroda, Jinichi; Yamashita, Akihiro; Sato, Hayato; Sato, Mamoru; Eto, Shinkichi; Onishi, Yasunori; Tanaka, Keiko; Kato, Satoshi

    2016-07-08

    Increasing numbers of patients with elevated anti-N-methyl-D-aspartate (NMDA) receptor antibody titers presenting exclusively with psychiatric symptoms have been reported. The aim of the present study was to clarify the prevalence of elevated serum anti-NMDA receptor antibody titers in patients with new-onset or acute exacerbations of psychiatric symptoms. In addition, the present study aimed to investigate the association between elevated anti-NMDA receptor titers and psychiatric symptoms. The present collaborative study included 59 inpatients (23 male, 36 female) presenting with new-onset or exacerbations of schizophrenia-like symptoms at involved institutions from June 2012 to March 2014. Patient information was collected using questionnaires. Anti-NMDA receptor antibody titers were measured using NMDAR NR1 and NR2B co-transfected human embryonic kidney (HEK) 293 cells as an antigen (cell-based assay). Statistical analyses were performed for each questionnaire item. The mean age of participants was 42.0 ± 13.7 years. Six cases had elevated serum anti-NMDA antibody titers (10.2 %), four cases were first onset, and two cases with disease duration >10 years presented with third and fifth recurrences. No statistically significant difference in vital signs or major symptoms was observed between antibody-positive and antibody-negative groups. However, a trend toward an increased frequency of schizophrenia-like symptoms was observed in the antibody-positive group. Serum anti-NMDA receptor antibody titers may be associated with psychiatric conditions. However, an association with specific psychiatric symptoms was not observed in the present study. Further studies are required to validate the utility of serum anti-NMDA receptor antibody titer measurements at the time of symptom onset.

  11. Allogeneic BMT and patient eligibility based on psychosocial criteria: a survey of BMT professionals.

    Science.gov (United States)

    Foster, L W; McLellan, L J; Rybicki, L A; Dabney, J; Welsh, E; Bolwell, B J

    2006-01-01

    BMT professionals were compared regarding their willingness to proceed with allogeneic BMT given select psychosocial issues. A questionnaire was sent to 660 physician members of ASBMT, 92 social work members of BMT Special Interest Group, Association of Oncology Social Work, and 626 nurse members of BMT Special Interest Group, Oncology Nursing Society; 597 responded with a response rate of 43.5%. Items included background information, followed by 17 case vignettes; each represented a different psychosocial issue to which respondents indicated whether or not they would recommend proceeding with allogeneic BMT. In every vignette, at least 10% of respondents indicated they would not proceed. In six vignettes, at least 64% indicated do not proceed: suicidal ideation (86.8%), uses addictive illicit drugs (81.7%), history of noncompliance (80.5%), no lay caregiver (69.3%), alcoholic (64.8%), and mild dementia/Alzheimer's (64.4%). In 10 vignettes, at least 73% indicated proceed. On four vignettes, professional subgroups differed in their recommendation on whether or not to proceed with allogeneic BMT. Qualitative data suggest that this decision is contingent on the perceived acuity, severity, and currency of the psychosocial issue, patient ability to comply with treatment given the issue, and its manageability as a risk factor for treatment related vulnerability and outcomes.

  12. Generalized Safety and Efficacy of Simplified Intravenous Thrombolysis Treatment (SMART) Criteria in Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Sørensen, Sigrid B; Barazangi, Nobl; Chen, Charlene

    2016-01-01

    BACKGROUND: Common intravenous recombinant tissue plasminogen activator (IV rt-PA) exclusion criteria may substantially limit the use of thrombolysis. Preliminary data have shown that the SMART (Simplified Management of Acute stroke using Revised Treatment) criteria greatly expand patient...... eligibility by reducing thrombolysis exclusions, but they have not been assessed on a large scale. We evaluated the safety and efficacy of general adoption of SMART thrombolysis criteria to a large regional stroke network. METHODS: Retrospective analysis of consecutive patients who received IV thrombolysis...... within a regional stroke network was performed. Patients were divided into those receiving thrombolysis locally versus at an outside hospital. The primary outcome was modified Rankin Scale score (≤1) at discharge and the main safety outcome was symptomatic intracranial hemorrhage (sICH) rate. RESULTS...

  13. Symptoms of Fibromyalgia According to the 2016 Revised Fibromyalgia Criteria in Chronic Pain Patients Referred to Multidisciplinary Pain Rehabilitation: Influence on Clinical and Experimental Pain Sensitivity

    DEFF Research Database (Denmark)

    Plesner, Karin Bruun; Vaegter, Henrik Bjarke

    2018-01-01

    Fibromyalgia is a condition with chronic widespread pain and signs of generalized pain hypersensitivity. FM has previously been classified according to the ACR1990 criteria, where the presence of hypersensitivity is estimated by a tender point examination. Due to the limitations of these classifi......Fibromyalgia is a condition with chronic widespread pain and signs of generalized pain hypersensitivity. FM has previously been classified according to the ACR1990 criteria, where the presence of hypersensitivity is estimated by a tender point examination. Due to the limitations...... of these classification criteria, new diagnostic criteria have been proposed, abandoning this examination. This cross-sectional study investigated the prevalence of FM according to the revised 2016 FM criteria in a large cohort of chronic pain patients. Pain drawings, the Fibromyalgia Symptom Severity Scale...

  14. Distal biceps brachii tendon repair: a systematic review of patient outcome determination using modified Coleman methodology score criteria.

    Science.gov (United States)

    Nyland, John; Causey, Brandon; Wera, Jeff; Krupp, Ryan; Tate, David; Gupta, Amit

    2017-07-01

    This systematic literature review evaluated the methodological research design quality of studies that evaluated patient outcomes following distal biceps brachii tendon repair and developed evidence-based recommendations for future patient clinical outcomes research. Following the preferred reporting items for systematic reviews and meta-analyses criteria, and using "biceps brachii", "tendon", "repair" and "outcome assessment" search terms, the CINAHL, Academic Search Premier and MEDLINE databases were searched from January 1960-October 2015. The modified Coleman methodology score (MCMS) served as the primary outcome measure. Descriptive statistical analysis was performed for composite and component MCMS and for patient outcome assessment methodology use frequency. A total of 93 studies were evaluated. Overall MCMS was low (57.1 ± 14). Only 12 (12.9 %) had prospective cohort or randomized controlled trial designs. There was a moderate relationship between publication year and MCMS (r = 0.53, P research study methodological scores improved on average since 2008, generally low MCMS scores, retrospective designs, lack of eccentric elbow flexor or supinator strength testing, and poorly described surgical and rehabilitation descriptions remain commonplace. These findings decrease clinical study validity and generalizability. III.

  15. Clinical value of DSM IV and DSM 5 criteria for diagnosing the most prevalent somatoform disorders in patients with medically unexplained physical symptoms (MUPS).

    Science.gov (United States)

    van Dessel, Nikki Claassen-; van der Wouden, Johannes C; Dekker, Joost; van der Horst, Henriette E

    2016-03-01

    This study aimed (1) to describe frequencies of DSM IV somatisation disorder, undifferentiated somatoform disorder and pain disorder versus DSM 5 somatic symptom disorder (SSD) in a multi-setting population of patients with medically unexplained physical symptoms (MUPS), (2) to investigate differences in sociodemographic and (psycho)pathological characteristics between these diagnostic groups and (3) to explore the clinical relevance of the distinction between mild and moderate DSM 5 SSD. We used baseline data of a cohort of 325 MUPS patients. Measurements included questionnaires about symptom severity, physical functioning, anxiety, depression, health anxiety and illness perceptions. These questionnaires were used as proxy measures for operationalization of DSM IV and DSM 5 diagnostic criteria. 92.9% of participants fulfilled criteria of a DSM IV somatoform disorder, while 45.5% fulfilled criteria of DSM 5 SSD. Participants fulfilling criteria of DSM 5 SSD suffered from more severe symptoms than those only fulfilling criteria of a DSM IV somatoform disorder(mean PHQ-15 score of 13.98 (SD 5.17) versus 11.23 (SD 4.71), P-valuephysical functioning was significantly lower. Compared to patients with mild SSD, patients with moderate SSD suffered from significantly lower physical functioning and higher levels of depression. Within a population of MUPS patients DSM 5 SSD criteria are more restrictive than DSM IV criteria for somatoform disorders. They are associated with higher symptom severity and lower physical functioning. However, further specification of the positive psychological criteria of DSM 5 SSD may improve utility in research and practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Importance of cerebrospinal fluid analysis in the era of McDonald 2010 criteria: a German-Austrian retrospective multicenter study in patients with a clinically isolated syndrome.

    Science.gov (United States)

    Huss, André M; Halbgebauer, Steffen; Öckl, Patrick; Trebst, Corinna; Spreer, Annette; Borisow, Nadja; Harrer, Andrea; Brecht, Isabel; Balint, Bettina; Stich, Oliver; Schlegel, Sabine; Retzlaff, Nele; Winkelmann, Alexander; Roesler, Romy; Lauda, Florian; Yildiz, Özlem; Voß, Elke; Muche, Rainer; Rauer, Sebastian; Bergh, Florian Then; Otto, Markus; Paul, Friedemann; Wildemann, Brigitte; Kraus, Jörg; Ruprecht, Klemens; Stangel, Martin; Buttmann, Mathias; Zettl, Uwe K; Tumani, Hayrettin

    2016-12-01

    The majority of patients presenting with a first clinical symptom suggestive of multiple sclerosis (MS) do not fulfill the MRI criteria for dissemination in space and time according to the 2010 revision of the McDonald diagnostic criteria for MS and are thus classified as clinically isolated syndrome (CIS). To re-evaluate the utility of cerebrospinal fluid (CSF) analysis in the context of the revised McDonald criteria from 2010, we conducted a retrospective multicenter study aimed at determining the prevalence and predictive value of oligoclonal IgG bands (OCBs) in patients with CIS. Patients were recruited from ten specialized MS centers in Germany and Austria. We collected data from 406 patients; at disease onset, 44/406 (11 %) fulfilled the McDonald 2010 criteria for MS. Intrathecal IgG OCBs were detected in 310/362 (86 %) of CIS patients. Those patients were twice as likely to convert to MS according to McDonald 2010 criteria as OCB-negative individuals (hazard ratio = 2.1, p = 0.0014) and in a shorter time period of 25 months (95 % CI 21-34) compared to 47 months in OCB-negative individuals (95 % CI 36-85). In patients without brain lesions at first attack and presence of intrathecal OCBs (30/44), conversion rate to MS was 60 % (18/30), whereas it was only 21 % (3/14) in those without OCBs. Our data confirm that in patients with CIS the risk of conversion to MS substantially increases if OCBs are present at onset. CSF analysis definitely helps to evaluate the prognosis in patients who do not have MS according to the revised McDonald criteria.

  17. Simplified response monitoring criteria for multiple myeloma in patients undergoing therapy with novel agents using computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Schabel, Christoph; Horger, Marius; Kum, Sara [Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Weisel, Katja [Department of Internal Medicine II – Hematology & Oncology, Eberhard-Karls-University Tuebingen, Otfried-Müller-Str. 5, 72076 Tuebingen (Germany); Fritz, Jan [Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 600 N Wolfe St., Baltimore, MD 21287 (United States); Ioanoviciu, Sorin D. [Department of Internal Medicine, Clinical Municipal Hospital Timisoara, Gheorghe Dima Str. 5, 300079 Timisoara (Romania); Bier, Georg, E-mail: georg.bier@med.uni-tuebingen.de [Department of Neuroradiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)

    2016-12-15

    Highlights: • A simplified method for response monitoring of multiple myeloma is proposed. • Medullary bone lesions of all limbs were included and analysed. • Diameters of ≥2 medullary bone lesions are sufficient for therapy monitoring. - Abstract: Introduction: Multiple myeloma is a malignant hematological disorder of the mature B-cell lymphocytes originating in the bone marrow. While therapy monitoring is still mainly based on laboratory biomarkers, the additional use of imaging has been advocated due to inaccuracies of serological biomarkers or in a-secretory myelomas. Non-enhanced CT and MRI have similar sensitivities for lesions in yellow marrow-rich bone marrow cavities with a favourable risk and cost-effectiveness profile of CT. Nevertheless, these methods are still limited by frequently high numbers of medullary lesions and its time consumption for proper evaluation. Objective: To establish simplified response criteria by correlating size and CT attenuation changes of medullary multiple myeloma lesions in the appendicular skeleton with the course of lytic bone lesions in the entire skeleton. Furthermore to evaluate these criteria with respect to established hematological myeloma-specific parameters for the prediction of treatment response to bortezomib or lenalidomide. Materials and methods: Non-enhanced reduced-dose whole-body CT examinations of 78 consecutive patients (43 male, 35 female, mean age 63.69 ± 9.2 years) with stage III multiple myeloma were retrospectively re-evaluated. On per patient basis, size and mean CT attenuation of 2–4 representative lesions in the limbs were measured at baseline and at a follow-up after a mean of 8 months. Results were compared with the course of lytical bone lesions as well with that of specific hematological biomarkers. Myeloma response was assessed according to the International Myeloma Working Group (IMWG) uniform response criteria. Testing for correlation between response of medullary lesions (Resp

  18. Opioid-use disorder among patients on long-term opioid therapy: impact of final DSM-5 diagnostic criteria on prevalence and correlates.

    Science.gov (United States)

    Boscarino, Joseph A; Hoffman, Stuart N; Han, John J

    2015-01-01

    Previously, we estimated the prevalence and risk factors for prescription opioid-use disorder among outpatients on opioid therapy using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and DSM-4 criteria. However, at the time, the DSM-5 criteria were not finalized. In the current study, we analyzed these data using the final DSM-5 criteria and compared these results. Using electronic records from a large US health care system, we identified outpatients receiving five or more prescription orders for opioid therapy in the past 12 months for noncancer pain (mean prescription orders =10.72; standard deviation =4.96). In 2008, we completed diagnostic interviews with 705 of these patients using the DSM-4 criteria. In the current study, we reassessed these results using the final DSM-5 criteria. The lifetime prevalence of DSM-5 opioid-use disorders using the final DSM-5 criteria was 58.7% for no or few symptoms (DSM-4 criteria indicated that the majority of patients with lifetime DSM-4 opioid dependence were now classified as having mild opioid-use disorder, based on the DSM-5 criteria (53.6%; 95% CI =44.1-62.8). In ordinal logistic regression predicting no/few, mild, moderate, and severe opioid-use disorder, the best predictors were age DSM-5 criteria, including the elimination of tolerance and withdrawal, inclusion of craving and abuse symptoms, and introduction of a new graded severity classification, the prevalence of opioid-use disorders has changed, while many of the DSM-4 risk factors for opioid dependence were similar. To our knowledge, this is one of the first studies to compare the final results for DSM-5 versus DSM-4 prescription opioid-use disorders among a high-risk patient population.

  19. Most Trial Eligibility Criteria and Patient Baseline Characteristics Do Not Modify Treatment Effect in Trials Using Targeted Therapies for Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Christensen, Anton Wulf; Tarp, Simon; Furst, Daniel E

    2015-01-01

    OBJECTIVE: To determine if variations in trial eligibility criteria and patient baseline characteristics could be considered effect modifiers of the treatment response when testing targeted therapies (biological agents and targeted synthetic disease modifying antirheumatic drugs (DMARDs....... Odds ratios (ORs) were calculated from the response rates and compared among the trial eligibility criteria/patient baseline characteristics of interest. Comparisons are presented as the Ratio of Odds Ratios (ROR). RESULTS: Sixty-two trials (19,923 RA patients) were included in the primary analyses...... using ACR20 response. Overall, targeted therapies constituted an effective treatment (OR 3.96 95% confidence interval (CI) 3.41 to 4.60). The majority of the trial eligibility criteria and patient baseline characteristics did not modify treatment effect. The added benefit of targeted therapies was lower...

  20. Elevated metallothionein-bound cadmium concentrations in urine from bladder carcinoma patients, investigated by size exclusion chromatography-inductively coupled plasma mass spectrometry

    Energy Technology Data Exchange (ETDEWEB)

    Wolf, Christian [Department of Molecular Trace Element Research in the Life Sciences, Helmholtz Centre Berlin for Materials and Energy, Glienicker Str. 100, 14109 Berlin (Germany)], E-mail: wolf@helmholtz-berlin.de; Strenziok, Romy [Department of Urology, Charite University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin (Germany); Kyriakopoulos, Antonios [Department of Molecular Trace Element Research in the Life Sciences, Helmholtz Centre Berlin for Materials and Energy, Glienicker Str. 100, 14109 Berlin (Germany)

    2009-01-12

    Cadmium is discussed as being involved in the development of transitional cell carcinoma (TCC) of the bladder and can be observed in urine of these patients. Investigations of urinary samples from bladder cancer patients and normal controls were carried out with special emphasis on metallothionein (MT)-bound cadmium. Compounds that are constituents of urine were separated in urine samples by means of size exclusion chromatography and cadmium was monitored continuously with a hyphenated inductively coupled plasma mass spectrometry (ICP-MS) system. MT-bound cadmium was quantified by peak area integration, taking into account the intensity of the rhodium signal which was added continuously before ICP-MS detection. The obtained results show that urinary cadmium is predominantly bound to the observed MT-fraction. The median of the MT-bound cadmium concentration in the control group was found to be 0.8 {mu}g L{sup -1} whereas the cancer group has a median of 1.8 {mu}g L{sup -1}. The variance of the data in the cancer group is much higher than in the controls. However, the urinary MT-bound cadmium is significantly elevated in the cancer group; odds-ratio test: 7.11 (95% C.I.: 1.89-26.80), taking into account the total protein content. Due to the fact that only one main cadmium-containing fraction was observed, there is no necessity to separate the MT-fraction before cadmium determination in urine samples in future studies.

  1. Diagnostics of Sacroiliitis According to ASAS Criteria: A Comparative Evaluation of Conventional Radiographs and MRI in Patients with a Clinical Suspicion of Spondyloarthropathy. Preliminary Results

    International Nuclear Information System (INIS)

    Sudoł-Szopińska, Iwona; Kwiatkowska, Brygida; Włodkowska-Korytkowska, Monika; Matuszewska, Genowefa; Grochowska, Elżbieta

    2015-01-01

    The objective of this study was a comparative evaluation of radiography and MRI in the diagnostics of sacroiliitis in patients with a clinical diagnosis of spondyloartropathy, according to the current ASAS criteria. Sacroiliac joints radiograms and MRI were conducted in 101 consecutive patients, aged 19–71 yrs (mean age: 40.6 yrs). The patients were referred by a senior rheumatologist, with symptoms of the chronic back pain. The sacroiliac joints were assessed on AP radiograms of the pelvis according to the modified New York criteria for ankylosing spondylitis. MRI was performed to look for active and chronic inflammatory lesions. Of 14 patients with radiographic sacroiliitis according to modified New York criteria, only 50% had sacroiliitis on MRI. The sensitivity and specificity of conventional radiography were 22% and 94% and of MRI were 71% and 90%. Cohen’s kappa coefficient was κ=0.0187, agreement of radiograms and MRI was 58%. Among 86 patients displaying no sacroiliitis on radiograms, MRI showed sacroiliitis in 34 patients (39.5%). Positive predictive value was 0.429, negative predictive value was 0.605. MRI allowed to diagnose sacroiliitis in 39,5 % of patients in preradiographic stage. MRI ruled out the presence of active inflammatory lesions in 60.4% of patients with sacroiliitis on radiograms according to modified New York criteria

  2. Predicting Outcomes After Chemo-Embolization in Patients with Advanced-Stage Hepatocellular Carcinoma: An Evaluation of Different Radiologic Response Criteria

    International Nuclear Information System (INIS)

    Gunn, Andrew J.; Sheth, Rahul A.; Luber, Brandon; Huynh, Minh-Huy; Rachamreddy, Niranjan R.; Kalva, Sanjeeva P.

    2017-01-01

    PurposeThe purpse of this study was to evaluate the ability of various radiologic response criteria to predict patient outcomes after trans-arterial chemo-embolization with drug-eluting beads (DEB-TACE) in patients with advanced-stage (BCLC C) hepatocellular carcinoma (HCC).Materials and methodsHospital records from 2005 to 2011 were retrospectively reviewed. Non-infiltrative lesions were measured at baseline and on follow-up scans after DEB-TACE according to various common radiologic response criteria, including guidelines of the World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), the European Association for the Study of the Liver (EASL), and modified RECIST (mRECIST). Statistical analysis was performed to see which, if any, of the response criteria could be used as a predictor of overall survival (OS) or time-to-progression (TTP).Results75 patients met inclusion criteria. Median OS and TTP were 22.6 months (95 % CI 11.6–24.8) and 9.8 months (95 % CI 7.1–21.6), respectively. Univariate and multivariate Cox analyses revealed that none of the evaluated criteria had the ability to be used as a predictor for OS or TTP. Analysis of the C index in both univariate and multivariate models showed that the evaluated criteria were not accurate predictors of either OS (C-statistic range: 0.51–0.58 in the univariate model; range: 0.54–0.58 in the multivariate model) or TTP (C-statistic range: 0.55–0.59 in the univariate model; range: 0.57–0.61 in the multivariate model).ConclusionCurrent response criteria are not accurate predictors of OS or TTP in patients with advanced-stage HCC after DEB-TACE.

  3. Predicting Outcomes After Chemo-Embolization in Patients with Advanced-Stage Hepatocellular Carcinoma: An Evaluation of Different Radiologic Response Criteria

    Energy Technology Data Exchange (ETDEWEB)

    Gunn, Andrew J., E-mail: agunn@uabmc.edu [University of Alabama at Birmingham, Division of Vascular and Interventional Radiology (United States); Sheth, Rahul A. [MD Anderson Cancer Center, Division of Interventional Radiology (United States); Luber, Brandon [Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Divison of Biostatistics and Bioinformatics (United States); Huynh, Minh-Huy [Johns Hopkins University School of Medicine (United States); Rachamreddy, Niranjan R. [Massachusetts General Hospital/Harvard Medical School, Department of Radiology (United States); Kalva, Sanjeeva P. [University of Texas Southwestern Medical Center, Division of Interventional Radiology, Department of Radiology (United States)

    2017-01-15

    PurposeThe purpse of this study was to evaluate the ability of various radiologic response criteria to predict patient outcomes after trans-arterial chemo-embolization with drug-eluting beads (DEB-TACE) in patients with advanced-stage (BCLC C) hepatocellular carcinoma (HCC).Materials and methodsHospital records from 2005 to 2011 were retrospectively reviewed. Non-infiltrative lesions were measured at baseline and on follow-up scans after DEB-TACE according to various common radiologic response criteria, including guidelines of the World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), the European Association for the Study of the Liver (EASL), and modified RECIST (mRECIST). Statistical analysis was performed to see which, if any, of the response criteria could be used as a predictor of overall survival (OS) or time-to-progression (TTP).Results75 patients met inclusion criteria. Median OS and TTP were 22.6 months (95 % CI 11.6–24.8) and 9.8 months (95 % CI 7.1–21.6), respectively. Univariate and multivariate Cox analyses revealed that none of the evaluated criteria had the ability to be used as a predictor for OS or TTP. Analysis of the C index in both univariate and multivariate models showed that the evaluated criteria were not accurate predictors of either OS (C-statistic range: 0.51–0.58 in the univariate model; range: 0.54–0.58 in the multivariate model) or TTP (C-statistic range: 0.55–0.59 in the univariate model; range: 0.57–0.61 in the multivariate model).ConclusionCurrent response criteria are not accurate predictors of OS or TTP in patients with advanced-stage HCC after DEB-TACE.

  4. Evaluation of Immune-Related Response Criteria and RECIST v1.1 in Patients With Advanced Melanoma Treated With Pembrolizumab.

    Science.gov (United States)

    Hodi, F Stephen; Hwu, Wen-Jen; Kefford, Richard; Weber, Jeffrey S; Daud, Adil; Hamid, Omid; Patnaik, Amita; Ribas, Antoni; Robert, Caroline; Gangadhar, Tara C; Joshua, Anthony M; Hersey, Peter; Dronca, Roxana; Joseph, Richard; Hille, Darcy; Xue, Dahai; Li, Xiaoyun Nicole; Kang, S Peter; Ebbinghaus, Scot; Perrone, Andrea; Wolchok, Jedd D

    2016-05-01

    We evaluated atypical response patterns and the relationship between overall survival and best overall response measured per immune-related response criteria (irRC) and Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1) in patients with advanced melanoma treated with pembrolizumab in the phase Ib KEYNOTE-001 study (clinical trial information: NCT01295827). Patients received pembrolizumab 2 or 10 mg/kg every 2 weeks or every 3 weeks. Atypical responses were identified by using centrally assessed irRC data in patients with ≥ 28 weeks of imaging. Pseudoprogression was defined as ≥ 25% increase in tumor burden at week 12 (early) or any assessment after week 12 (delayed) that was not confirmed as progressive disease at next assessment. Response was assessed centrally per irRC and RECIST v1.1. Of the 655 patients with melanoma enrolled, 327 had ≥ 28 weeks of imaging follow-up. Twenty-four (7%) of these 327 patients had atypical responses (15 [5%] with early pseudoprogression and nine [3%] with delayed pseudoprogression). Of the 592 patients who survived ≥ 12 weeks, 84 (14%) experienced progressive disease per RECIST v1.1 but nonprogressive disease per irRC. Two-year overall survival rates were 77.6% in patients with nonprogressive disease per both criteria (n = 331), 37.5% in patients with progressive disease per RECIST v1.1 but nonprogressive disease per irRC (n = 84), and 17.3% in patients with progressive disease per both criteria (n = 177). Atypical responses were observed in patients with melanoma treated with pembrolizumab. Based on survival analysis, conventional RECIST might underestimate the benefit of pembrolizumab in approximately 15% of patients; modified criteria that permit treatment beyond initial progression per RECIST v1.1 might prevent premature cessation of treatment. © 2016 by American Society of Clinical Oncology.

  5. Social Exclusion Anxiety

    DEFF Research Database (Denmark)

    Søndergaard, Dorte Marie

    2017-01-01

    Social exclusion anxiety is a term which builds on a social-psychological concept of human beings as existentially dependent on social embeddedness. This entry explores the concept in relation to bullying among children, which is a widespread and serious problem in schools and institutions. Social...... exclusion anxiety and longing for belonging are both central aspects of the affects and processes that enact and challenge social groups. Social exclusion anxiety should not be confused with ‘social phobia’, which is a concept within clinical psychology that focuses on the individual and refers to a phobic...... psychological condition. Social exclusion anxiety instead points to a distributed affect which circulates and smolders in all social groups. This is the result of an ever-present risk of someone being judged unworthy to belong to, or deemed not a legitimate participant in, a social group. Such anxiety may...

  6. Evaluation of local hospital discharge for thyroid cancer patients treated with Iodine-131; comparison with internationally accepted release criteria

    International Nuclear Information System (INIS)

    Stylianou-Markidou, E.; Peraticou, A.; Constantinou, C.; Giannos, A.; Aritkan, A.V.; Dimitriadou, D.; Frangos, S.

    2007-01-01

    Full text: Aim: Patients with Thyroid Cancer treated with I-131 in our institution, stay in a shielded room for two days, or until they emit less than 40 μSv/hr at 1m, based on the Cyprus legislation for radiation protection. Other countries have different regulations and public dose limits, and their hospital discharge guidelines vary accordingly. The purpose of this study is to evaluate local hospital discharge regulations, make a comparison with other countries' accepted release criteria, and find where improvements can be made. Methods: 267 patients were treated with I-131 (activity 1.8-8.9GBq) from September 2001 to April 2007. The dose equivalent rate (DER) was measured within 30 min of the administration at a distance of 1 m from the patient. Measurements at 1m were also obtained before the release of the patient. For a group of these patients, measurements were also carried out a week after the treatment with I-131. The doses given to members of the public, from each of the above patients, were calculated using the Total Effective Dose Equivalent (TEDE) concept, which is based on the line source model. For 10% of these patients, measurements of the dose emitted to surroundings were taken, using two different methods. (a) Doses were measured with TLD dosimeters placed at specific points of the room during the two day restriction of the patient in the shielded room. These points were at bedside, at 1 m from the patient's bed, at 3m from the patient's bed, in the shower area, and at the side of the toilet. (b) On the day of release, personal dosimeters were given to a member of the immediate family (carer) of the patient for a minimum of five days. The skin dose and dose at approximately 10cm depth were measured by the National personnel monitoring for radiation protection authority of Cyprus. Results: Our calculation of the TEDE values indicated that, had the patients been released just after the administration of the radiopharmaceutical, members of the

  7. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria.

    LENUS (Irish Health Repository)

    Gallagher, P F

    2011-06-01

    Inappropriate prescribing is particularly common in older patients and is associated with adverse drug events (ADEs), hospitalization, and wasteful utilization of resources. We randomized 400 hospitalized patients aged ≥ 65 years to receive either the usual pharmaceutical care (control) or screening with STOPP\\/START criteria followed up with recommendations to their attending physicians (intervention). The Medication Appropriateness Index (MAI) and Assessment of Underutilization (AOU) index were used to assess prescribing appropriateness, both at the time of discharge and for 6 months after discharge. Unnecessary polypharmacy, the use of drugs at incorrect doses, and potential drug-drug and drug-disease interactions were significantly lower in the intervention group at discharge (absolute risk reduction 35.7%, number needed to screen to yield improvement in MAI = 2.8 (95% confidence interval 2.2-3.8)). Underutilization of clinically indicated medications was also reduced (absolute risk reduction 21.2%, number needed to screen to yield reduction in AOU = 4.7 (95% confidence interval 3.4-7.5)). Significant improvements in prescribing appropriateness were sustained for 6 months after discharge.

  8. The Cervical Dystonia Impact Profile (CDIP-58: Can a Rasch developed patient reported outcome measure satisfy traditional psychometric criteria?

    Directory of Open Access Journals (Sweden)

    Bhatia Kailash P

    2008-08-01

    Full Text Available Abstract Background The United States Food and Drug Administration (FDA are currently producing guidelines for the scientific adequacy of patient reported outcome measures (PROMs in clinical trials, which will have implications for the selection of scales used in future clinical trials. In this study, we examine how the Cervical Dystonia Impact Profile (CDIP-58, a rigorous Rasch measurement developed neurologic PROM, stands up to traditional psychometric criteria for three reasons: 1 provide traditional psychometric evidence for the CDIP-58 in line with proposed FDA guidelines; 2 enable researchers and clinicians to compare it with existing dystonia PROMs; and 3 help researchers and clinicians bridge the knowledge gap between old and new methods of reliability and validity testing. Methods We evaluated traditional psychometric properties of data quality, scaling assumptions, targeting, reliability and validity in a group of 391 people with CD. The main outcome measures used were the CDIP-58, Medical Outcome Study Short Form-36, the 28-item General Health Questionnaire, and Hospital and Anxiety and Depression Scale. Results A total of 391 people returned completed questionnaires (corrected response rate 87%. Analyses showed: 1 data quality was high (low missing data ≤ 4%, subscale scores could be computed for > 96% of the sample; 2 item groupings passed tests for scaling assumptions; 3 good targeting (except for the Sleep subscale, ceiling effect = 27%; 4 good reliability (Cronbach's alpha ≥ 0.92, test-retest intraclass correlations ≥ 0.83; and 5 validity was supported. Conclusion This study has shown that new psychometric methods can produce a PROM that stands up to traditional criteria and supports the clinical advantages of Rasch analysis.

  9. Epidemiological study of schizophrenia in the Chernobyl exclusion zone personnel

    International Nuclear Information System (INIS)

    Loganovsky, K.N.; Nyagu, A.I.

    1997-01-01

    Nakane and Ohta (1986) revealed very high (6 %) prevalence rate of schizophrenia in A-bomb survivors. The goal of this study was the epidemiological investigation of schizophrenia in the Chernobyl exclusion zone personnel on the base of 10-years follow up study and analysis of the psychiatric archives (1986-1996). As a result the register of schizophrenia spectrum disorders has been created, including 65 staff members. According to both ICD-9 and ICD-10 criteria there were 48 patients with schizophrenia. It has been revealed a statistically significant increase of the schizophrenia percentage amongst all psychoses in the Chernobyl exclusion zone personnel in comparison with the general Ukrainian population. It has been established that among 48 cases of schizophrenia there were 39 (81.2 %) of schizophrenia onset occurred in the zone. Since 1990 a significant increase (more than 4 times: 5.4 per 10,000 in the zone and 1.1 per 10,000 in Ukraine) in schizophrenia incidence has been taking place among the irradiated population of the exclusion zone in comparison with the general population. Our data testify to possibility of radiation-induced schizophrenia onset, which seem to be like stochastic effects of ionizing radiation. The mechanisms of these effects realization are the subject of further investigations. (author)

  10. Joint involvement in patients with early polymyalgia rheumatica using high-resolution ultrasound and its contribution to the EULAR/ACR 2012 classification criteria for polymyalgia rheumatica.

    Science.gov (United States)

    Weigand, Sandra; Ehrenstein, Boris; Fleck, Martin; Hartung, Wolfgang

    2014-04-01

    To assess joint involvement and the contribution of musculoskeletal ultrasound (MSUS) to the novel European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) 2012 classification criteria in patients with polymyalgia rheumatic (PMR). MSUS was performed in 54 consecutive patients with recent-onset PMR. Biceps tenosynovitis of at least 1 shoulder has been observed in 70.4% of patients, and 64.8% had a bilateral biceps tenosynovitis. Subdeltoid bursitis (27.8% unilateral, 5.6% bilateral), glenohumeral synovitis (22.2% unilateral, 9.3% bilateral), and hip involvement (22.2% unilateral, 16.7% bilateral) were observed less frequently. The sensitivities of the classification criteria were 85.2% for EULAR/ACR without MSUS and 81.5% for EULAR/ACR with MSUS. The most common MSUS pathology was a biceps tenosynovitis. However, US findings had no effect on the sensitivity of the novel EULAR/ACR criteria for PMR.

  11. Food and Drug Administration criteria for the diagnosis of drug-induced valvular heart disease in patients previously exposed to benfluorex: a prospective multicentre study.

    Science.gov (United States)

    Maréchaux, Sylvestre; Rusinaru, Dan; Jobic, Yannick; Ederhy, Stéphane; Donal, Erwan; Réant, Patricia; Arnalsteen, Elise; Boulanger, Jacques; Garban, Thierry; Ennezat, Pierre-Vladimir; Jeu, Antoine; Szymanski, Catherine; Tribouilloy, Christophe

    2015-02-01

    The Food and Drug Administration (FDA) criteria for diagnosis of drug-induced valvular heart disease (DIVHD) are only based on the observation of aortic regurgitation ≥ mild and/or mitral regurgitation ≥ moderate. We sought to evaluate the diagnostic value of FDA criteria in a cohort of control patients and in a cohort of patients exposed to a drug (benfluorex) known to induce VHD. This prospective, multicentre study included 376 diabetic control patients not exposed to valvulopathic drugs and 1000 subjects previously exposed to benfluorex. Diagnosis of mitral or aortic DIVHD was based on a combined functional and morphological echocardiographic analysis of cardiac valves. Patients were classified according to the FDA criteria [mitral or aortic-FDA(+) and mitral or aortic-FDA(-)]. Among the 376 control patients, 2 were wrongly classified as mitral-FDA(+) and 17 as aortic-FDA(+) (0.53 and 4.5% of false positives, respectively). Of those exposed to benfluorex, 48 of 58 with a diagnosis of mitral DIVHD (83%) were classified as mitral-FDA(-), and 901 of the 910 patients (99%) without a diagnosis of the mitral DIVHD group were classified as mitral-FDA(-). All 40 patients with a diagnosis of aortic DIVHD were classified as aortic-FDA(+), and 105 of the 910 patients without a diagnosis of aortic DIVHD (12%) were classified aortic-FDA(+). Older age and lower BMI were independent predictors of disagreement between FDA criteria and the diagnosis of DIVHD in patients exposed to benfluorex (both P ≤ 0.001). FDA criteria solely based on the Doppler detection of cardiac valve regurgitation underestimate for the mitral valve and overestimate for the aortic valve the frequency of DIVHD. Therefore, the diagnosis of DIVHD must be based on a combined echocardiographic and Doppler morphological and functional analysis of cardiac valves. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  12. Comparison of RECIST, EORTC criteria and PERCIST for evaluation of early response to chemotherapy in patients with non-small-cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shang, Jingjie; Ling, Xueying; Zhang, Linyue; Tang, Yongjin; Xiao, Zeyu; Cheng, Yong; Guo, Bin; Gong, Jian; Huang, Li; Xu, Hao [The First Affiliated Hospital of Jinan University, Department of Nuclear Medicine and PET/CT-MRI Centre, Guangzhou (China)

    2016-10-15

    To compare the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the European Organization for Research and Treatment of Cancer (EORTC) criteria and the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) 1.0 using PET volume computer-assisted reading (PET VCAR) for response evaluation in patients with advanced non-small-cell lung cancer (NSCLC) treated with chemotherapy. A total of 35 patients with NSCLC were included in this prospective study. All patients received standard chemotherapy and underwent {sup 18}F-FDG PET/CT scans before and after treatment. With the assistance of PET VCAR, the chemotherapeutic responses were evaluated according to the RECIST 1.1, EORTC criteria and PERCIST 1.0. Concordance among these protocols was assessed using Cohen's κ coefficient and Wilcoxon's signed-ranks test. Progression-free survival (PFS) was calculated using the Kaplan-Meier test. RECIST 1.1 and EORTC response classifications were discordant in 20 patients (57.1 %; κ = 0.194, P < 0.05), and RECIST 1.1 and PERCIST 1.0 classifications were discordant in 22 patients (62.9 %; κ = 0.139, P < 0.05). EORTC and PERCIST 1.0 classifications were discordant in only 4 patients (11.4 %), resulting in better concordance (κ = 0.804, P > 0.05). Patients with a partial remission according to RECIST 1.1 had significantly longer PFS (P < 0.001) than patients with progressive disease, but not significantly longer than patients with stable disease (P = 0.855). According to both the EORTC criteria and PERCIST 1.0, patients with a partial metabolic response had a significantly longer PFS than those with stable metabolic disease and those with progressive metabolic disease (P = 0.020 and P < 0.001, respectively, for EORTC; both P < 0.001 for PERCIST 1.0). EORTC criteria and PERCIST 1.0 are more sensitive and accurate than RECIST 1.1 for the detection of an early therapeutic response to chemotherapy in patients with NSCLC. Although EORTC criteria and

  13. Comparison of RECIST, EORTC criteria and PERCIST for evaluation of early response to chemotherapy in patients with non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Shang, Jingjie; Ling, Xueying; Zhang, Linyue; Tang, Yongjin; Xiao, Zeyu; Cheng, Yong; Guo, Bin; Gong, Jian; Huang, Li; Xu, Hao

    2016-01-01

    To compare the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the European Organization for Research and Treatment of Cancer (EORTC) criteria and the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) 1.0 using PET volume computer-assisted reading (PET VCAR) for response evaluation in patients with advanced non-small-cell lung cancer (NSCLC) treated with chemotherapy. A total of 35 patients with NSCLC were included in this prospective study. All patients received standard chemotherapy and underwent 18 F-FDG PET/CT scans before and after treatment. With the assistance of PET VCAR, the chemotherapeutic responses were evaluated according to the RECIST 1.1, EORTC criteria and PERCIST 1.0. Concordance among these protocols was assessed using Cohen's κ coefficient and Wilcoxon's signed-ranks test. Progression-free survival (PFS) was calculated using the Kaplan-Meier test. RECIST 1.1 and EORTC response classifications were discordant in 20 patients (57.1 %; κ = 0.194, P < 0.05), and RECIST 1.1 and PERCIST 1.0 classifications were discordant in 22 patients (62.9 %; κ = 0.139, P < 0.05). EORTC and PERCIST 1.0 classifications were discordant in only 4 patients (11.4 %), resulting in better concordance (κ = 0.804, P > 0.05). Patients with a partial remission according to RECIST 1.1 had significantly longer PFS (P < 0.001) than patients with progressive disease, but not significantly longer than patients with stable disease (P = 0.855). According to both the EORTC criteria and PERCIST 1.0, patients with a partial metabolic response had a significantly longer PFS than those with stable metabolic disease and those with progressive metabolic disease (P = 0.020 and P < 0.001, respectively, for EORTC; both P < 0.001 for PERCIST 1.0). EORTC criteria and PERCIST 1.0 are more sensitive and accurate than RECIST 1.1 for the detection of an early therapeutic response to chemotherapy in patients with NSCLC. Although EORTC criteria and

  14. Symptom presentations and other characteristics of colorectal cancer patients and the diagnostic performance of the Auckland Regional Grading Criteria for Suspected Colorectal Cancer in the South Auckland population.

    Science.gov (United States)

    Hsiang, John C; Bai, Wayne; Lal, Dinesh

    2013-09-13

    This study reviews the presenting symptoms of colorectal cancer in the ethnically diverse Middlemore Hospital referral population of South Auckland, New Zealand. The performance of the newly introduced Auckland Regional Grading Criteria as prediction tool for selecting colorectal cancer cases referred from primary care was evaluated in this group. Retrospective review of all colorectal cancer (CRC) cases diagnosed between January 2006 and January 2011. Information extracted from case note review was used to grade patients using the Auckland Regional Grading Criteria. A total of 799 patients were included. The commonest symptoms were: rectal bleeding (25.5-42.3%) and change in bowel habit (20.6-26.8%). Low-risk symptoms including abdominal pain (16.3-46.8%) and weight loss (18.4-26.1%) were not uncommon. 64.4% of Maori and 64.9% of Pacific patients had stage III or IV cancers. Pacific patients had more stage IV disease, 37.7% (pAuckland Regional Grading Criteria would miss 24.7% of the patients with CRC in the referral population. While rectal bleeding and change in bowel habit are frequent presenting symptoms, low-risk atypical symptoms including constipation, weight loss and abdominal pain were not uncommon. Significant proportion of Pacific patients present with late-stage disease. The current Auckland Regional grading criteria would miss significant proportion of our study population with colorectal cancer.

  15. Potentially inappropriate medicines in elderly hospitalised patients according to the EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol.

    Science.gov (United States)

    Mucalo, Iva; Hadžiabdić, Maja Ortner; Brajković, Andrea; Lukić, Sonja; Marić, Patricia; Marinović, Ivana; Bačić-Vrca, Vesna

    2017-08-01

    The aim of this study was to measure the prevalence of potentially inappropriate medications (PIMs) by using the EU(7)-PIM list, STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) version 2 criteria and the new comprehensive protocol. This prospective study involved a sample of 276 consecutive elderly patients discharged from the university teaching hospital. Age, gender, diagnoses, medication history and medicines at discharge were recorded. The main outcome measure was the prevalence of PIMs according to each set of criteria: EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. The median patient age (range) was 74 (65-92) years. The median number of prescribed medications was 7 (1-17). STOPP identified 393 PIMs affecting 190 patients (69%), EU(7)-PIM list identified 330 PIMs in 184 patients (66.7%) whilst the comprehensive protocol identified 134 PIMs in 102 patients (37%). STOPP version 2 criteria identified significantly more PIMs per patient than the other two protocols (p comprehensive protocol and was found as a more sensitive tool for PIM detection.

  16. Early coordinated multidisciplinary intervention to prevent sickness absence and labour market exclusion in patients with low back pain: study protocol of a randomized controlled trial.

    Science.gov (United States)

    Fisker, Annette; Langberg, Henning; Petersen, Tom; Mortensen, Ole Steen

    2013-03-13

    -statement in designing and reporting RCTs. This large RCT is testing the effectiveness of a preventive intervention targeting patients on short term sick leave or at risk being sick listed because of low back pain. We have developed a novel multidisciplinary team structure using the treating physiotherapist as the return to work coordinator, and having the case manager from the municipal sickness benefit office participating in team meetings. The study has the potential to contribute to the knowledge about how to target the challenges in the treatment of LBP. The aim is to prevent sickness absence and labour market exclusion--both on the individual level and economic costs at community level. Short term results will be available in 2014.This study is approved by the Danish Regional Ethics Committee (J.nr: H-C-2008-112) and is registered at ClinicalTrials.gov: NCT01690234.

  17. Opioid-use disorder among patients on long-term opioid therapy: impact of final DSM-5 diagnostic criteria on prevalence and correlates

    Science.gov (United States)

    Boscarino, Joseph A; Hoffman, Stuart N; Han, John J

    2015-01-01

    Aims Previously, we estimated the prevalence and risk factors for prescription opioid-use disorder among outpatients on opioid therapy using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and DSM-4 criteria. However, at the time, the DSM-5 criteria were not finalized. In the current study, we analyzed these data using the final DSM-5 criteria and compared these results. Methods Using electronic records from a large US health care system, we identified outpatients receiving five or more prescription orders for opioid therapy in the past 12 months for noncancer pain (mean prescription orders =10.72; standard deviation =4.96). In 2008, we completed diagnostic interviews with 705 of these patients using the DSM-4 criteria. In the current study, we reassessed these results using the final DSM-5 criteria. Results The lifetime prevalence of DSM-5 opioid-use disorders using the final DSM-5 criteria was 58.7% for no or few symptoms (DSM-5 criteria (53.6%; 95% CI =44.1–62.8). In ordinal logistic regression predicting no/few, mild, moderate, and severe opioid-use disorder, the best predictors were age DSM-5 criteria, including the elimination of tolerance and withdrawal, inclusion of craving and abuse symptoms, and introduction of a new graded severity classification, the prevalence of opioid-use disorders has changed, while many of the DSM-4 risk factors for opioid dependence were similar. To our knowledge, this is one of the first studies to compare the final results for DSM-5 versus DSM-4 prescription opioid-use disorders among a high-risk patient population. PMID:26316838

  18. The efficacy of cladribine tablets in CIS patients retrospectively assigned the diagnosis of MS using modern criteria: Results from the ORACLE-MS study.

    Science.gov (United States)

    Freedman, Mark S; Leist, Thomas P; Comi, Giancarlo; Cree, Bruce Ac; Coyle, Patricia K; Hartung, Hans-Peter; Vermersch, Patrick; Damian, Doris; Dangond, Fernando

    2017-01-01

    Multiple sclerosis (MS) diagnostic criteria have changed since the ORACLE-MS study was conducted; 223 of 616 patients (36.2%) would have met the diagnosis of MS vs clinically isolated syndrome (CIS) using the newer criteria. The objective of this paper is to assess the effect of cladribine tablets in patients with a first clinical demyelinating attack fulfilling newer criteria (McDonald 2010) for MS vs CIS. A post hoc analysis for subgroups of patients retrospectively classified as fulfilling or not fulfilling newer criteria at the first clinical demyelinating attack was conducted. Cladribine tablets 3.5 mg/kg ( n  = 68) reduced the risk of next attack or three-month confirmed Expanded Disability Status Scale (EDSS) worsening by 74% vs placebo ( n  = 72); p  = 0.0009 in patients meeting newer criteria for MS at baseline. Cladribine tablets 5.25 mg/kg ( n  = 83) reduced the risk of next attack or three-month confirmed EDSS worsening by 37%, but nominal significance was not reached ( p  = 0.14). In patients who were still CIS after applying newer criteria, cladribine tablets 3.5 mg/kg ( n  = 138) reduced the risk of conversion to clinically definite multiple sclerosis (CDMS) by 63% vs placebo ( n  = 134); p  = 0.0003. Cladribine tablets 5.25 mg/kg ( n  = 121) reduced the risk of conversion by 75% vs placebo ( n  = 134); p  ORACLE-MS study (NCT00725985).

  19. Sarcopenia and its individual criteria are associated, in part, with mortality among patients on hemodialysis.

    Science.gov (United States)

    Kittiskulnam, Piyawan; Chertow, Glenn M; Carrero, Juan J; Delgado, Cynthia; Kaysen, George A; Johansen, Kirsten L

    2017-07-01

    The relative importance of sarcopenia and its individual components as independent predictors of mortality in the dialysis population has not been determined. We estimated whole-body muscle mass using pre-dialysis bioimpedance spectroscopy measurements in 645 ACTIVE/ADIPOSE-enrolled prevalent hemodialysis patients from San Francisco and Atlanta. Low muscle mass was defined as two standard deviations below sex-specific means for young adults from NHANES and indexed to height 2 , body weight, body surface area, or body mass index. We evaluated the association of sarcopenia (low muscle mass) by four indexing methods, weak hand grip strength, and slow gait speed with mortality. Seventy-eight deaths were observed during a mean follow-up of 1.9 years. Sarcopenia was not significantly associated with mortality after adjusting for covariates. No muscle mass criteria were associated with death, regardless of indexing metrics. In contrast, having weak grip strength or slow walking speed was associated with mortality in the adjusted model. Only gait slowness significantly improved the predictive accuracy for death with an increase in C-statistic from 0.63 to 0.68. However, both gait slowness and hand grip weakness significantly improved the net reclassification index compared to models without performance measures (50.5% for slowness and 33.7% for weakness), whereas models with muscle size did not. Neither sarcopenia nor low muscle mass by itself was a better predictor of mortality than functional limitation alone in patients receiving hemodialysis. Thus, physical performance measures, including slow gait speed and weak hand grip strength, were associated with mortality even after adjustment for muscle size and other confounders. Published by Elsevier Inc.

  20. Importance of liver biopsy findings in immunosuppression management: biopsy monitoring and working criteria for patients with operational tolerance.

    Science.gov (United States)

    2012-10-01

    Obstacles to morbidity-free long-term survival after liver transplantation (LT) include complications of immunosuppression (IS), recurrence of the original disease and malignancies, and unexplained chronic hepatitis and graft fibrosis. Many programs attempt to minimize chronic exposure to IS by reducing dosages and stopping steroids. A few programs have successfully weaned a highly select group of recipients from all IS without apparent adverse consequences, but long-term follow-up is limited. Patients subjected to adjustments in IS are usually followed by serial liver chemistry tests, which are relatively insensitive methods for detecting allograft damage. Protocol biopsy has largely been abandoned for hepatitis C virus-negative recipients, at least in part because of the inability to integrate routine histopathological findings into a rational clinical management algorithm. Recognizing a need to more precisely categorize and determine the clinical significance of findings in long-term biopsy samples, the Banff Working Group on Liver Allograft Pathology has reviewed the literature, pooled the experience of its members, and proposed working definitions for biopsy changes that (1) are conducive to lowering IS and are compatible with operational tolerance (OT) and (2) raise concern for closer follow-up and perhaps increased IS during or after IS weaning. The establishment of guidelines should help us to standardize analyses of the effects of various treatments and/or weaning protocols and more rigorously categorize patients who are assumed to show OT. Long-term follow-up using standardized criteria will help us to determine the consequences of lowering IS and to define and determine the incidence and robustness of OT in liver allografts. Copyright © 2012 American Association for the Study of Liver Diseases.

  1. Criteria CSR

    OpenAIRE

    Vovk, V.; Zateyshikova, O.

    2014-01-01

    In the article the theoretical aspects regarding criteria for assessing CSR proposed by A. Carroll, including: economic, legal, ethical, philanthropic. Based on this, it is proposed to characterize these criteria with respect to the interested parties (stakeholders), including: investors, shareholders suppliers, customers, employees, society and the state. This will make a qualitative assessment of the presence and depth using social responsibility in the company, as well as determine the ext...

  2. Potentially inappropriate medications in elderly Japanese patients: effects of pharmacists' assessment and intervention based on Screening Tool of Older Persons' Potentially Inappropriate Prescriptions criteria ver.2.

    Science.gov (United States)

    Kimura, T; Ogura, F; Yamamoto, K; Uda, A; Nishioka, T; Kume, M; Makimoto, H; Yano, I; Hirai, M

    2017-04-01

    The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (stopp) criteria were updated in 2014 (stopp criteria ver.2), but few studies have evaluated the usefulness of stopp criteria in elderly patients. This prospective observational study evaluated the prevalence of potentially inappropriate medications (PIMs), and the efficacy of hospital pharmacists' assessment and intervention based on stopp criteria ver.2. The study was conducted at three medical units of Kobe University Hospital between April 2015 and March 2016. Pharmacists assessed and detected PIMs based on stopp criteria ver.2 and considered the patient's intention to change the prescription at the time of admission of each patient. If the pharmacists judged that benefits outweighed risks of prescription change and the patients consented to change the medications, they recommended the doctor to change the prescription. If there was a risk of exacerbation of disease by the change of medications and the pharmacists judged it to be difficult to adjust medications during hospitalization or the patients did not consent to change the medications, they did not recommend to change it. The pharmacists and the doctors discussed and finally decided whether to change the PIMs or not. The number of patients prescribed PIMs, the number and contents of PIMs, and the number of medications changed after pharmacists' intervention were calculated. Totally, 822 new inpatients aged ≥65 years prescribed ≥1 daily medicine were included. Their median (interquartile range) age was 75·0 (71·0-80·0) years, and 54·9% were male. According to the criteria, 346 patients (42·1%) were prescribed ≥1 PIMs. Patients prescribed PIMs took significantly more medications than others: 10·0 (7·0-13·0) vs. 6·0 (4·0-9·0), P older people (benzodiazepines) (30/67) and (iii) drugs that predictably increase the risk of falls in older people (hypnotic Z-drugs) (15/31). Over 40% elderly patients were prescribed PIMs

  3. Utility of the American-European Consensus Group and American College of Rheumatology Classification Criteria for Sjögren's syndrome in patients with systemic autoimmune diseases in the clinical setting.

    Science.gov (United States)

    Hernández-Molina, Gabriela; Avila-Casado, Carmen; Nuñez-Alvarez, Carlos; Cárdenas-Velázquez, Francisco; Hernández-Hernández, Carlos; Luisa Calderillo, María; Marroquín, Verónica; Recillas-Gispert, Claudia; Romero-Díaz, Juanita; Sánchez-Guerrero, Jorge

    2015-03-01

    The aim of this study was to evaluate the feasibility and performance of the American-European Consensus Group (AECG) and ACR Classification Criteria for SS in patients with systemic autoimmune diseases. Three hundred and fifty patients with primary SS, SLE, RA or scleroderma were randomly selected from our patient registry. Each patient was clinically diagnosed as probable/definitive SS or non-SS following a standardized evaluation including clinical symptoms and manifestations, confirmatory tests, fluorescein staining test, autoantibodies, lip biopsy and medical chart review. Using the clinical diagnosis as the gold standard, the degree of agreement with each criteria set and between the criteria sets was estimated. One hundred fifty-four (44%) patients were diagnosed with SS. The AECG criteria were incomplete in 36 patients (10.3%) and the ACR criteria in 96 (27.4%; P vs 62.3 and a specificity of 94.3 vs 91.3, respectively. Either set of criteria was met by 123 patients (80%); 95 (61.7%) met the AECG criteria and 96 (62.3%) met the ACR criteria, but only 68 (44.2%) patients met both sets. The concordance rate between clinical diagnosis and AECG or ACR criteria was moderate (k statistic 0.58 and 0.55, respectively). Among 99 patients with definitive SS sensitivity was 83.3 vs 77.7 and specificity was 90.8 vs 85.6, respectively. A discrepancy between clinical diagnosis and criteria was seen in 59 patients (17%). The feasibility of the SS AECG criteria is superior to that of the ACR criteria, however, their performance was similar among patients with systemic autoimmune diseases. A subset of SS patients is still missed by both criteria sets. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

    LENUS (Irish Health Repository)

    Barry, P J

    2012-02-03

    BACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers\\' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers\\' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers\\' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +\\/- 6.1 years) and all patients had both Beers\\' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community

  5. Clinical utility of new bleeding criteria: a prospective study of evaluation for the Bleeding Academic Research Consortium definition of bleeding in patients undergoing percutaneous coronary intervention.

    Science.gov (United States)

    Choi, Jae-Hyuk; Seo, Jeong-Min; Lee, Dong Hyun; Park, Kyungil; Kim, Young-Dae

    2015-04-01

    The aim of this study was to evaluate the clinical utility of the new bleeding criteria, proposed by the Bleeding Academic Research Consortium (BARC), compared with the old criteria for determining the action of physicians in contact with bleeding events, after percutaneous coronary intervention (PCI). The BARC criteria were independently associated with an increased risk of 1-year mortality after PCI, and provided a predictive value, in regard to 1-year mortality. The standardized bleeding definitions will be expected to help the physician to correctly analyze the bleeding events, to select an optimal treatment, and to objectively compare the results of multiple trials and registries. All the patients undergoing PCI from June to September 2012 were prospectively enrolled. Patients who experienced a bleeding event were further classified, based on three different bleeding severity criteria: BARC, Thrombolysis In Myocardial Infarction (TIMI), and Global Use of Strategies To Open coronary arteries (GUSTO). The primary outcome was the occurrence of bleeding events requiring interruption of antiplatelet therapy (IAT) by physicians. A total of 376 consecutive patients were included in this study. Total bleeding events occurred in 46 patients (12.2%). BARC type ≥2 bleeding occurred in 30 patients (8.0%); however, TIMI major or minor bleeding, and GUSTO moderate or severe bleeding occurred in 6 (1.6%) and 11 patients (2.9%), respectively. Of the 46 patients, 28 (60.9% of patients) required IAT. On receiver-operating characteristic curve analysis, bleeding defined BARC type ≥2 effectively predicted IAT, with a sensitivity of 89.3%, and a specificity of 98.5% (pdefinition may be a more useful tool for the detection of bleeding with clinical relevance, for patients undergoing PCI. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  6. The Pauli Exclusion Principle

    Indian Academy of Sciences (India)

    his exclusion principle, the quantum theory was a mess. Moreover, it could ... This is a function of all the coordinates and 'internal variables' such as spin, of all the ... must remain basically the same (ie change by a phase factor at most) if we ...

  7. Exclusive Production at CMS

    CERN Document Server

    Walczak, Marek

    2016-01-01

    I briefly introduce so-called central exclusive production. I mainly focus on the example analyses that have been performed in the CMS experiment at CERN. I conclude with ideas and perspectives for future work that will be done during Run 2 of the LHC. I pay special attention to the ultraperipheral collisions.

  8. Ombuds' Corner: Social exclusion

    CERN Document Server

    Vincent Vuillemin

    2012-01-01

    In this special video edition of the Ombuds' Corner, Vincent Vuillemin takes a look at a social exclusion at CERN. Please note that the characters and situations appearing in this work are fictitious, and any resemblance to real persons or events is purely coincidental.   Contact the Ombuds Early!

  9. Social exclusion of children

    NARCIS (Netherlands)

    Annette Roest; Anne Marike Lokhorst; Cok Vrooman

    2010-01-01

    Original title: Sociale uitsluiting bij kinderen. Combating social exclusion of children is a subject that has received growing attention in Dutch government policy in recent years. To date, however, no analysis has been performed to ascertain the extent and origins of this phenomenon. This

  10. Evaluating bronchodilator response in pediatric patients with post-infectious bronchiolitis obliterans: use of different criteria for identifying airway reversibility.

    Science.gov (United States)

    Mattiello, Rita; Vidal, Paula Cristina; Sarria, Edgar Enrique; Pitrez, Paulo Márcio; Stein, Renato Tetelbom; Mocelin, Helena Teresinha; Fischer, Gilberto Bueno; Jones, Marcus Herbert; Pinto, Leonardo Araújo

    2016-01-01

    Post-infectious bronchiolitis obliterans (PIBO) is a clinical entity that has been classified as constrictive, fixed obstruction of the lumen by fibrotic tissue. However, recent studies using impulse oscillometry have reported bronchodilator responses in PIBO patients. The objective of this study was to evaluate bronchodilator responses in pediatric PIBO patients, comparing different criteria to define the response. We evaluated pediatric patients diagnosed with PIBO and treated at one of two pediatric pulmonology outpatient clinics in the city of Porto Alegre, Brazil. Spirometric parameters were measured in accordance with international recommendations. We included a total of 72 pediatric PIBO patients. The mean pre- and post-bronchodilator values were clearly lower than the reference values for all parameters, especially FEF25-75%. There were post-bronchodilator improvements. When measured as mean percent increases, FEV1 and FEF25-75%, improved by 11% and 20%, respectively. However, when the absolute values were calculated, the mean FEV1 and FEF25-75% both increased by only 0.1 L. We found that age at viral aggression, a family history of asthma, and allergy had no significant effects on bronchodilator responses. Pediatric patients with PIBO have peripheral airway obstruction that is responsive to treatment but is not completely reversible with a bronchodilator. The concept of PIBO as fixed, irreversible obstruction does not seem to apply to this population. Our data suggest that airway obstruction is variable in PIBO patients, a finding that could have major clinical implications. A bronquiolite obliterante pós-infecciosa (BOPI) é uma entidade clínica que tem sido classificada como obstrução fixa e constritiva do lúmen por tecido fibrótico. Entretanto, estudos recentes utilizando oscilometria de impulso relataram resposta ao broncodilatador em pacientes com BOPI. O objetivo deste estudo foi avaliar a resposta broncodilatadora em pacientes pediátricos com

  11. Are symptoms of spirit possessed patients covered by the DSM-IV or DSM-5 criteria for possession trance disorder? A mixed-method explorative study in Uganda.

    Science.gov (United States)

    van Duijl, Marjolein; Kleijn, Wim; de Jong, Joop

    2013-09-01

    As in many cultures, spirit possession is a common idiom of distress in Uganda. The DSM-IV contains experimental research criteria for dissociative and possession trance disorder (DTD and PTD), which are under review for the DSM-5. In the current proposed categories of the DSM-5, PTD is subsumed under dissociative identity disorder (DID) and DTD under dissociative disorders not elsewhere classified. Evaluation of these criteria is currently urgently required. This study explores the match between local symptoms of spirit possession in Uganda and experimental research criteria for PTD in the DSM-IV and proposed criteria for DID in the DSM-5. A mixed-method approach was used combining qualitative and quantitative research methods. Local symptoms were explored of 119 spirit possessed patients, using illness narratives and a cultural dissociative symptoms' checklist. Possible meaningful clusters of symptoms were inventoried through multiple correspondence analysis. Finally, local symptoms were compared with experimental criteria for PTD in the DSM-IV and proposed criteria for DID in the DSM-5. Illness narratives revealed different phases of spirit possession, with passive-influence experiences preceding the actual possession states. Multiple correspondence analysis of symptoms revealed two dimensions: 'passive' and 'active' symptoms. Local symptoms, such as changes in consciousness, shaking movements, and talking in a voice attributed to spirits, match with DSM-IV-PTD and DSM-5-DID criteria. Passive-influence experiences, such as feeling influenced or held by powers from outside, strange dreams, and hearing voices, deserve to be more explicitly described in the proposed criteria for DID in the DSM-5. The suggested incorporation of PTD in DID in the DSM-5 and the envisioned separation of DTD and PTD in two distinctive categories have disputable aspects.

  12. Opioid-use disorder among patients on long-term opioid therapy: impact of final DSM-5 diagnostic criteria on prevalence and correlates

    Directory of Open Access Journals (Sweden)

    Boscarino JA

    2015-08-01

    Full Text Available Joseph A Boscarino,1 Stuart N Hoffman,1 John J Han2 1Center for Health Research, 2Department of Pain Medicine, Geisinger Clinic, Danville, PA, USAAims: Previously, we estimated the prevalence and risk factors for prescription opioid-use disorder among outpatients on opioid therapy using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 and DSM-4 criteria. However, at the time, the DSM-5 criteria were not finalized. In the current study, we analyzed these data using the final DSM-5 criteria and compared these results.Methods: Using electronic records from a large US health care system, we identified outpatients receiving five or more prescription orders for opioid therapy in the past 12 months for noncancer pain (mean prescription orders =10.72; standard deviation =4.96. In 2008, we completed diagnostic interviews with 705 of these patients using the DSM-4 criteria. In the current study, we reassessed these results using the final DSM-5 criteria.Results: The lifetime prevalence of DSM-5 opioid-use disorders using the final DSM-5 criteria was 58.7% for no or few symptoms (<2, 28.1% for mild symptoms (2–3, 9.7% for moderate symptoms (4–5, and 3.5% for severe symptoms (six or more. Thus, the lifetime prevalence of “any” prescription opioid-use disorder in this cohort was 41.3% (95% confidence interval [CI] =37.6–45.0. A comparison to the DSM-4 criteria indicated that the majority of patients with lifetime DSM-4 opioid dependence were now classified as having mild opioid-use disorder, based on the DSM-5 criteria (53.6%; 95% CI =44.1–62.8. In ordinal logistic regression predicting no/few, mild, moderate, and severe opioid-use disorder, the best predictors were age <65 years, current pain impairment, trouble sleeping, suicidal thoughts, anxiety disorders, illicit drug use, and history of substance abuse treatment.Conclusion: Given the final DSM-5 criteria, including the elimination of tolerance and withdrawal, inclusion of

  13. Combining the IADPSG criteria with the WHO diagnostic criteria for ...

    African Journals Online (AJOL)

    Macrosomia or at least one adverse outcome were more likely in GDM patients who met the diagnostic criteria by both the IADPSG and WHO criteria (P = 0.001). Conclusion: A diagnosis of GDM that meets both the WHO and IADPSG criteria provides stronger prediction for adverse pregnancy outcome than a diagnosis that ...

  14. Candidate lesion-based criteria for defining a positive sacroiliac joint MRI in two cohorts of patients with axial spondyloarthritis

    DEFF Research Database (Denmark)

    Weber, Ulrich; Østergaard, Mikkel; Lambert, Robert G W

    2015-01-01

    OBJECTIVE: To determine candidate lesion-based criteria for a positive sacroiliac joint (SIJ) MRI based on bone marrow oedema (BMO) and/or erosion in non-radiographic axial spondyloarthritis (nr-axSpA); to compare the performance of lesion-based criteria with global evaluation by expert readers. ...... for classification of axial SpA, reflecting the contextual information provided by T1SE and STIR sequences....

  15. Assessment of Newly Proposed Clinical Criteria to Identify HNF1A MODY in Patients with an Initial Diagnosis of Type 1 or Type 2 Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Malgorzata Grzanka

    2016-01-01

    Full Text Available The most common form of maturity-onset diabetes of the young (MODY is caused by mutations in the hepatocyte nuclear factor 1A (HNF1A gene. However, most HNF1A mutation-carriers are initially misdiagnosed with type 1 (T1DM or type 2 (T2DM diabetes mellitus; hence, they often receive nonoptimal treatment. The aim of our study was to test newly proposed clinical criteria for the identification of HNF1A MODY in patients with a diagnosis of T1DM or T2DM. To achieve this, the following criteria to preselect patients for screening were used: for T1DM: TDIR (total daily insulin requirement > 0.3 IU of insulin/kg and the percentage of basal insulin > 30% of TDIR; for T2DM: sulphonylurea- (SU- based oral treatment (monotherapy or combined with Metformin > 15 years and BMI < 30 kg/m2. We reviewed the clinical data of 140 patients with T1DM and 524 clinically diagnosed with T2DM. On the basis of these criteria, we found a HNF1A mutation in 1 out of 2 individuals with a diagnosis of T1DM and 1 out of 11 selected individuals with a diagnosis of T2DM. We believe that the simplicity of the proposed criteria might prove useful in clinical practice, as an alternative to more time-consuming classical diagnostic techniques.

  16. Assessment of Newly Proposed Clinical Criteria to Identify HNF1A MODY in Patients with an Initial Diagnosis of Type 1 or Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Grzanka, Malgorzata; Matejko, Bartlomiej; Szopa, Magdalena; Kiec-Wilk, Beata; Malecki, Maciej T; Klupa, Tomasz

    2016-01-01

    The most common form of maturity-onset diabetes of the young (MODY) is caused by mutations in the hepatocyte nuclear factor 1A (HNF1A) gene. However, most HNF1A mutation-carriers are initially misdiagnosed with type 1 (T1DM) or type 2 (T2DM) diabetes mellitus; hence, they often receive nonoptimal treatment. The aim of our study was to test newly proposed clinical criteria for the identification of HNF1A MODY in patients with a diagnosis of T1DM or T2DM. To achieve this, the following criteria to preselect patients for screening were used: for T1DM: TDIR (total daily insulin requirement) > 0.3 IU of insulin/kg and the percentage of basal insulin > 30% of TDIR; for T2DM: sulphonylurea- (SU-) based oral treatment (monotherapy or combined with Metformin) > 15 years and BMI < 30 kg/m(2). We reviewed the clinical data of 140 patients with T1DM and 524 clinically diagnosed with T2DM. On the basis of these criteria, we found a HNF1A mutation in 1 out of 2 individuals with a diagnosis of T1DM and 1 out of 11 selected individuals with a diagnosis of T2DM. We believe that the simplicity of the proposed criteria might prove useful in clinical practice, as an alternative to more time-consuming classical diagnostic techniques.

  17. Exclusive processes in QCD

    International Nuclear Information System (INIS)

    Mueller, A.H.

    1981-01-01

    In this talk I concentrate on purely exclusive processes. In Sec. II form factors and exclusive decays of heavy quarkonium states will be discussed. In Sec. III elastic wide angle elastic scattering will be considered with emphasis placed on the energy dependence for a fixed angle. The x → 1 limit of structure functions is discussed in Sec. IV. This is a limit which matches on, in a rather complicated way, with transition form factors. In Sec. V the idea of intrinsic charm is considered, mostly from a conceptual viewpoint as to its definition and possible existence. In Sec. VI there is a brief discussion of calculations of matrix elements which occur in deeply inelastic scattering by use of a bag model. In Sec. VII wee parton cancellations and Sudakov corrections for μ-pair production are considered. Sec. VIII concerns soft particle production and the mutliplicity of hadrons in a jet. (orig./HSI)

  18. Prognostic Value of FDG-PET, Based on the Revised Response Criteria, in Patients with Malignant Lymphoma: A Comparison with CT/MRI Evaluations, Based on the International Working Group/ Cotswolds Meeting Criteria

    Directory of Open Access Journals (Sweden)

    Kayako Isohashi

    2015-07-01

    Full Text Available Objective(s: Post-treatment evaluations by CT/MRI (based on the International Working Group/ Cotswolds meeting guidelines and PET (based on Revised Response Criteria, were examined in terms of progression-free survival (PFS in patients with malignant lymphoma (ML. Methods: 79 patients, undergoing CT/MRI for the examination of suspected lesions and whole-body PET/CT before and after therapy, were included in the study during April 2007-January 2013. The relationship between post-treatment evaluations (CT/MRI and PET and PFS during the follow-up period was examined, using Kaplan-Meier survival analysis. The patients were grouped according to the histological type into Hodgkin’s lymphoma (HL, diffuse large B-cell lymphoma (DLBCL, and other histological types. The association between post-treatment evaluations (PET or PET combined with CT/ MRI and PFS was examined separately. Moreover, the relationship between disease recurrence and serum soluble interleukin-2 receptor, lactic dehydrogenase, and C-reactive protein levels was evaluated before and after the treatment. Results: Patients with incomplete remission on both CT/MRI and PET had a significantly shorter PFS, compared to patients with complete remission on both CT/MRI and PET and those exhibiting incomplete remission on CT/MRI and complete remission on PET (P

  19. The psychology of exclusivity

    Directory of Open Access Journals (Sweden)

    Troy Jollimore

    2008-02-01

    Full Text Available Friendship and romantic love are, by their very nature, exclusive relationships. This paper suggests that we can better understand the nature of the exclusivity in question by understanding what is wrong with the view of practical reasoning I call the Comprehensive Surveyor View. The CSV claims that practical reasoning, in order to be rational, must be a process of choosing the best available alternative from a perspective that is as detached and objective as possible. But this view, while it means to be neutral between various value-bearers, in fact incorporates a bias against those value-bearers that can only be appreciated from a perspective that is not detached—that can only be appreciated, for instance, by agents who bear long-term commitments to the values in question. In the realm of personal relationships, such commitments tend to give rise to the sort of exclusivity that characterizes friendship and romantic love; they prevent the agent from being impartial between her beloved’s needs, interests, etc., and those of other persons. In such contexts, I suggest, needs and claims of other persons may be silenced in much the way that, as John McDowell has suggested, the temptations of immorality are silenced for the virtuous agent.

  20. Classification of neuropathic pain in cancer patients: A Delphi expert survey report and EAPC/IASP proposal of an algorithm for diagnostic criteria.

    Science.gov (United States)

    Brunelli, Cinzia; Bennett, Michael I; Kaasa, Stein; Fainsinger, Robin; Sjøgren, Per; Mercadante, Sebastiano; Løhre, Erik T; Caraceni, Augusto

    2014-12-01

    Neuropathic pain (NP) in cancer patients lacks standards for diagnosis. This study is aimed at reaching consensus on the application of the International Association for the Study of Pain (IASP) special interest group for neuropathic pain (NeuPSIG) criteria to the diagnosis of NP in cancer patients and on the relevance of patient-reported outcome (PRO) descriptors for the screening of NP in this population. An international group of 42 experts was invited to participate in a consensus process through a modified 2-round Internet-based Delphi survey. Relevant topics investigated were: peculiarities of NP in patients with cancer, IASP NeuPSIG diagnostic criteria adaptation and assessment, and standardized PRO assessment for NP screening. Median consensus scores (MED) and interquartile ranges (IQR) were calculated to measure expert consensus after both rounds. Twenty-nine experts answered, and good agreement was found on the statement "the pathophysiology of NP due to cancer can be different from non-cancer NP" (MED=9, IQR=2). Satisfactory consensus was reached for the first 3 NeuPSIG criteria (pain distribution, history, and sensory findings; MEDs⩾8, IQRs⩽3), but not for the fourth one (diagnostic test/imaging; MED=6, IQR=3). Agreement was also reached on clinical examination by soft brush or pin stimulation (MEDs⩾7 and IQRs⩽3) and on the use of PRO descriptors for NP screening (MED=8, IQR=3). Based on the study results, a clinical algorithm for NP diagnostic criteria in cancer patients with pain was proposed. Clinical research on PRO in the screening phase and on the application of the algorithm will be needed to examine their effectiveness in classifying NP in cancer patients. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  1. A web-based delphi study for eliciting helpful criteria in the positive diagnosis of hemophagocytic syndrome in adult patients.

    Science.gov (United States)

    Hejblum, Gilles; Lambotte, Olivier; Galicier, Lionel; Coppo, Paul; Marzac, Christophe; Aumont, Cédric; Fardet, Laurence

    2014-01-01

    The diagnosis of the reactive form of hemophagocytic syndrome in adults remains particularly difficult since none of the clinical or laboratory manifestations are specific. We undertook a study in order to elicit which features constitute helpful criteria for a positive diagnosis. In this Delphi study, the features investigated in the questionnaire and the experts invited to participate in the survey were issued from a bibliographic search. The questionnaire was iteratively proposed to experts via a web-based application with a feedback of the results observed at the preceding Delphi round. Experts were asked to label each investigated criterion in one of the following categories: absolutely required, important, of minor interest, or not assessable in the routine practice environment. A positive consensus was a priori defined as at least 75% answers observed in the categories absolutely required and important. The questionnaire investigated 26 criteria and 24 experts originating from 13 countries participated in the second and final Delphi round. A positive consensus was reached for the nine following criteria: unilineage cytopenia, bicytopenia, pancytopenia, presence of hemophagocytosis pictures on a bone marrow aspirate or on a tissue biopsy, high ferritin level, fever, organomegaly, presence of a predisposing underlying disease, and high level of lactate dehydrogenase. A negative consensus was reached for 13 criteria, and an absence of consensus was observed for 4 criteria. The study constitutes the first initiative to date for defining international guidelines devoted to the positive diagnosis of the reactive form of hemophagocytic syndrome.

  2. FDG PET/CT diagnostic criteria may need adjustment based on MRI to estimate the presurgical risk of extrapelvic infiltration in patients with uterine endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sudo, Satoko; Sakuragi, Noriaki [Hokkaido University Graduate School of Medicine, Department of Gynecology, Sapporo (Japan); Hattori, Naoya; Manabe, Osamu; Hirata, Kenji; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Kitaku, Sapporo (Japan); Kato, Fumi; Mimura, Rie; Magota, Keiichi; Sugimori, Hiroyuki [Hokkaido University Graduate School of Medicine, Department of Diagnostic and Interventional Radiology, Sapporo (Japan)

    2015-04-01

    The staging of endometrial cancer requires surgery which carries the risk of morbidity. FDG PET/CT combined with anatomical imaging may reduce the number of unnecessary lymphadenectomies by demonstrating the risk of extrapelvic infiltration. The purpose of this study was to optimize FDG PET/CT diagnostic criteria for risk assessment in endometrial cancer after first-line risk triage with MRI. The study population comprised 37 patients who underwent curative surgery for the treatment of endometrial cancer. First, the risk of extrapelvic infiltration was triaged using MRI. Second, multiple glucose metabolic profiles of the primary lesion were assessed with FDG PET/CT, and these were correlated with the histopathological risk of extrapelvic infiltration including lymphovascular space invasion (LVSI) and high-grade malignancy (grades 2 and 3). The results of histological correlation were used to adjust FDG PET/CT diagnostic criteria. Presurgical assessment using MRI was positive for deep (>50 %) myometrial invasion in 17 patients. The optimal FDG PET/CT diagnostic criteria vary depending on the results of MRI. Specifically, SUVmax (≥16.0) was used to indicate LVSI risk with an overall diagnostic accuracy of 88.2 % in patients with MRI findings showing myometrial invasion. High-grade malignancy did not correlate with any of metabolic profiles in this patient group. In the remaining patients without myometrial invasion, lesion glycolysis (LG) or metabolic volume were better indicators of LVSI than SUVmax with the same diagnostic accuracy of 80.0 %. In addition, LG (≥26.9) predicted high-grade malignancy with an accuracy of 72.2 %. Using the optimized cut-off criteria for LVSI, glucose metabolic profiling of primary lesions correctly predicted lymph node metastasis with an accuracy of 73.0 %, which was comparable with the accuracy of visual assessment for lymph node metastasis using MRI and FDG PET/CT. FDG PET/CT diagnostic criteria may need adjustment based on the

  3. Prognostic Value of FDG-PET, Based on the Revised Response Criteria, in Patients with Malignant Lymphoma: A Comparison with CT/MRI Evaluations, Based on the International Working Group/Cotswolds Meeting Criteria

    International Nuclear Information System (INIS)

    Isohashi, Kayako; Tatsumi, Mitsuaki; Kato, Hiroki; Fukushima, Kentaro; Maeda, Tetsuo; Watabe, Tadashi; Shimosegawa, Eku; Kanakura, Yuzuru; Hatazawa, Jun

    2015-01-01

    Post-treatment evaluations by CT/MRI (based on the International Working Group/Cotswolds meeting guidelines) and PET (based on Revised Response Criteria), were examined in terms of progression-free survival (PFS) in patients with malignant lymphoma (ML). 79 patients, undergoing CT/MRI for the examination of suspected lesions and whole-body PET/CT before and after therapy, were included in the study during April 2007-January 2013. The relationship between post-treatment evaluations (CT/MRI and PET) and PFS during the follow-up period was examined, using Kaplan-Meier survival analysis. The patients were grouped according to the histological type into Hodgkin’s lymphoma (HL), diffuse large B-cell lymphoma (DLBCL), and other histological types. The association between post-treatment evaluations (PET or PET combined with CT/MRI) and PFS was examined separately. Moreover, the relationship between disease recurrence and serum soluble interleukin-2 receptor, lactic dehydrogenase, and C-reactive protein levels was evaluated before and after the treatment. Patients with incomplete remission on both CT/MRI and PET had a significantly shorter PFS, compared to patients with complete remission on both CT/MRI and PET and those exhibiting incomplete remission on CT/MRI and complete remission on PET (P<0.001). Post-treatment PET evaluations were strongly correlated with patient outcomes in cases with HL or DLBCL (P<0.01) and other histological types (P<0.001). In patients with HL or DLBCL, incomplete remission on both CT/MRI and PET was associated with a significantly shorter PFS, compared to patients with complete remission on both CT/MRI and PET (P<0.05) and those showing incomplete remission on CT/MRI and complete remission on PET (P<0.01). In patients with other histological types, incomplete remission on both CT/MRI and PET was associated with a significantly shorter PFS, compared to cases with complete remission on both CT/MRI and PET (P<0.001). None of the serum parameters

  4. The Use of Multi-Criteria Decision Analysis Weight Elicitation Techniques in Patients with Mild Cognitive Impairment

    NARCIS (Netherlands)

    van Til, Janine Astrid; Dolan, James G.; Stiggelbout, Anne M.; Groothuis-Oudshoorn, Catharina Gerarda Maria; IJzerman, Maarten Joost

    2008-01-01

    Objective: To test the applicability of multi-criteria decision analysis preference elicitation techniques in cognitively impaired individuals. - Method: A convenience sample of 16 cognitively impaired subjects and 12 healthy controls was asked to participate in a small pilot study. The subjects

  5. The Use of Multi-Criteria Decision Analysis Weight Elicitation Techniques in Patients with Mild Cognitive Impairment : A Pilot Study

    NARCIS (Netherlands)

    van Til, Janine A.; Dolan, James G.; Stiggelbout, Anne M.; Groothuis, Karin C.G.M.; IJzerman, Maarten J.

    2008-01-01

    Objective: To test the applicability of multi-criteria decision analysis preference elicitation techniques in cognitively impaired individuals. Method: A convenience sample of 16 cognitively impaired subjects and 12 healthy controls was asked to participate in a small pilot study. The subjects

  6. Exclusion and authorization

    International Nuclear Information System (INIS)

    Cooper, J.R.

    2003-01-01

    'Everyone in the world is exposed to radiation from natural and artificial sources. Any realistic system of radiological protection must have a clearly defined scope if it is not to apply to the whole of mankind's activities'. This quote, from ICRP Publication 60 (ICRP, 1991), remains apposite. The main tool for defining scope is the concept of exclusion: situations, sources or exposures that are excluded from the system of radiological protection are, to all intents and purposes, ignored. Sources and exposures that are not excluded are within the scope of the system of protection and by inference within regulatory systems implementing ICRP recommendations. These sources and exposures should be subject to appropriate authorization by the relevant regulatory authority. In order to avoid excessive regulatory procedures, however, provisions should be made for granting an exemption in cases where it is clear that regulatory provisions are unnecessary. Exemption is a regulatory tool intended to facilitate efficient use of regulatory resources. Nevertheless, the regulatory act of granting exemptions is, in itself, a form of authorization and the material or situation so exempted remains within the regulatory system. This distinction between exclusion and exemption is an important one. Historically, the concept of exclusion has been applied to sources or exposures that are essentially unamenable to control because of their widespread nature. The usually quoted examples are cosmic radiation at ground level and 40 K in the body. Clearly, many exposures from natural sources could fall into this category. The challenges are firstly to establish a sound basis for deciding which should be excluded and which should be controlled, and secondly to see if the concept could or should be applied to artificial sources and exposures. These two questions are the subject of this paper. (author)

  7. Social exclusion anxiety

    DEFF Research Database (Denmark)

    Søndergaard, Dorte Marie

    2014-01-01

    . The concepts I work with are the need for belonging, social exclusion anxiety and the production of contempt and dignity by both children and adults. I develop a new definition of bullying, drawing upon Judith Butler’s (1999) concept of ‘abjection’ as well as Karen Barad’s concept of ‘intra-acting forces......’ (Barad 2007). My definition in this chapter contributed to the shorter definition of bullying in the Introduction (see page XX), but it is more fully developed here in relation to the types of mechanisms and processes involved. Barad’s term ‘intra-action’ helps draw attention to the mutually...

  8. Prediction of a multiple sclerosis diagnosis in patients with clinically isolated syndrome using the 2016 MAGNIMS and 2010 McDonald criteria

    DEFF Research Database (Denmark)

    Filippi, Massimo; Preziosa, Paolo; Meani, Alessandro

    2018-01-01

    of the distinction between symptomatic and asymptomatic lesions was suggested. We compared the performance of the 2010 McDonald and 2016 MAGNIMS criteria for multiple sclerosis diagnosis in a large multicentre cohort of patients with CIS to provide evidence to guide revisions of multiple sclerosis diagnostic......, 2017, 571 patients with CIS were screened, of whom 368 met all study inclusion criteria. At the last evaluation (median 50·0 months [IQR 27·0-78·4]), 189 (51%) of 368 patients developed clinically definite multiple sclerosis. At 36 months, the two DIS criteria showed high sensitivity (2010 McDonald 0......·32-0·50], and similar AUC (0·63 [0·57-0·68]). Inclusion of optic nerve evaluation resulted in similar sensitivity (0·92 [0·87-0·96]), and slightly lower specificity (0·26 [0·18-0·34]) and AUC (0·59 [0·55-0·64]). AUC values were also similar for DIT (2010 McDonald 0·61 [0·55-0·67] and 2016 MAGNIMS 0·61 [0...

  9. Social exclusion and education

    Directory of Open Access Journals (Sweden)

    Jokić Vesna

    2009-01-01

    Full Text Available Social exclusion is a process whereby certain individuals are pushed to the edge of society and prevented from participating fully by virtue of their poverty, or lack of basic competencies and lifelong learning opportunities or as a result of discrimination. This distances them from job, income and education opportunities as well as social and community networks and activities. Quality education (conditions and access/accessibility/availability is one of the factors that significantly influence the reduced social exclusion. In other words, education has is key role key role in ensuring social inclusion (equal opportunities and active social participation. At the same time, education and lifelong learning is established as the basis for achieving the goals of sustainable economic development (economy based on knowledge and to achieve social cohesion. Quality education is a prerequisite for progress, development and well-being of the community. Conditions and accessibility to education have become priorities of national reforms in most European countries. The subject of this paper is the educational structure of population of Serbia and the accessibility of education. The analysis covers the educational structure with regard to age, gender and type of settlement (city and other/villages settlements.

  10. Strengths, Limitations, and Geographical Discrepancies in the Eligibility Criteria for Sport Participation in Young Patients With Congenital Heart Disease.

    Science.gov (United States)

    Cantinotti, Massimiliano; Giordano, Raffaele; Assanta, Nadia; Murzi, Bruno; Melo, Manuel; Franchi, Eliana; Crocetti, Maura; Iervasi, Giorgio; Kutty, Shelby

    2017-07-21

    Benefits of physical activity has been shown in children with congenital heart disease (CHD). In several forms of CHD, the risk of sudden death remains a major concern both for parents and clinicians, who in turn will have to consider the risk-benefit ratio of sport participation versus restriction. A literature search was performed within the National Library of Medicine using the keywords: Sport, CHD, and Eligibility. The search was further refined by adding the keywords: Children, Adult, and Criteria. Fifteen published studies evaluating sport eligibility criteria in CHD were included. Seven documents from various scientific societies have been published in the past decade but which of them should be adopted remains unclear. Our research highlighted accuracy and consistency of the latest documents; however, differences have emerged between the US and European recommendations. Eligibility criteria were consistent between countries for simple congenital heart defects, whereas there are discrepancies for borderline conditions including moderate valvular lesions and mild or moderate residual defects after CHD repair. Furthermore, some of the more severe defects were not evaluated. Multiple recommendations have been made for the same CHD, and cut-off values used to define disease severity have varied. Published eligibility criteria have mainly focused on competitive sports. Little attention was paid to recreational activities, and the psychosocial consequences of activity restriction were seldom evaluated. Comprehensive consensus recommendations for sport eligibility evaluating all CHD types and stages of repair are needed. These should include competitive and recreational activities, use standardized classifications to grade disease severity, and address the consequences of restriction.

  11. PATHOMORPHOLOGICAL FEATURES OF BONE LESIONS AND CORRELATION OF CLINICAL, LABORATORY AND MORPHOMETRIC CRITERIA IN PATIENTS WITH LATENT SCLEROSING HEMATOGENOUS OSTEOMYELITIS (GARRÉ

    Directory of Open Access Journals (Sweden)

    V. V. Grigorovsky

    2018-01-01

    Full Text Available Introduction. Sclerosing hematogenous osteomyelitis of Garré (SHO holds a significant place among cases of latent hematogenous osteomyelitis. Pathomorphological studies of sclerosing hematogenous osteomyelitis are needed to improve differentiated diagnostics, to prognosticate morphology specifics of nidus and to choose the optimal treatment tactics.Purpose of the study — to identify statistical differences between manifestation patterns of various disease types and correlation between clinical, laboratorial and morphometric criteria of bone lesions in patients with sclerosing hematogenous osteomyelitis.Material and methods. The authors studied tissue fragments of affected bones of 25 patients with SHO which was diagnosed by clinical, laboratorial, visualizing and morphological methods. Gradation morphometric criteria were used to reflect condition of nidus tissues. The authors made the analysis of qualitative characters and correlation analysis of dependencies between clinical and laboratorial criteria on the one hand, and with morphometric criteria — on the other, and identified association factor. Results. Pathomorphological study of SHO nidus demonstrated variances of bone lesions in separate disease cases despite the overall similarity of morphological manifestation. About 2/3 of all cases correspond to fibrosing type whereby even small exudative inflammation sites are absent. In about 1/3 of all cases apart from fibrosis, osteosclerosis and remodeling, the osteomyelitis niduses contain microabscesses indicative of suppurative inflammation as well as the authors observed small sequestration. The maximum differences in patients with various types of SHO were identified in such parameters as share of stab microphages and erythrocyte sedimentation rate (ESR. In cases of long term morbidity the fibrosing disease type is prevailing, in cases of short term lesion (1–2 years — a fibrosing type with microabscesses formation.A series of

  12. Clinical Investigation of Adrenal Incidentalomas in Japanese Patients of the Fukuoka Region with Updated Diagnostic Criteria for Sub-clinical Cushing's Syndrome.

    Science.gov (United States)

    Abe, Ichiro; Sugimoto, Kaoru; Miyajima, Tetsumasa; Ide, Tomoko; Minezaki, Midori; Takeshita, Kaori; Takahara, Saori; Nakagawa, Midori; Fujimura, Yuki; Kudo, Tadachika; Miyajima, Shigero; Taira, Hiroshi; Ohe, Kenji; Ishii, Tatsu; Yanase, Toshihiko; Kobayashi, Kunihisa

    2018-04-27

    Objectives We retrospectively investigated the clinical and endocrinological characteristics of adrenal incidentalomas. Methods We studied 61 patients who had been diagnosed with adrenal incidentalomas and had undergone detailed clinical and endocrinological evaluations while hospitalized. We used common criteria to diagnose the functional tumors, but for sub-clinical Cushing's syndrome, we used an updated set of diagnosis criteria: serum cortisol ≥1.8 μg/dL after a positive response to a 1-mg dexamethasone suppression test if the patient has a low morning ACTH level (Cushing's syndrome and sub-clinical Cushing's syndrome), and 25 (41.0%) had non-functional tumors. Compared with the non-functional tumor group, the primary aldosteronism group and the cortisol-secreting adenoma group were significantly younger and had significantly lower rates of hypokalemia, whereas the pheochromocytoma group had significantly larger tumors and a significantly lower body mass index. Conclusion Our study found a larger percentage of functional tumors among adrenal incidentalomas than past reports, partly because we used a lower serum cortisol level after a dexamethasone suppression test to diagnose sub-clinical Cushing's syndrome and because all of the patients were hospitalized and could therefore receive more detailed examinations. Young patients with hypokalemia or lean patients with large adrenal tumors warrant particularly careful investigation.

  13. Diagnosing antiphospholipid syndrome: 'extra-criteria' manifestations and technical advances.

    Science.gov (United States)

    Sciascia, Savino; Amigo, Mary-Carmen; Roccatello, Dario; Khamashta, Munther

    2017-09-01

    First described in the early 1980s, antiphospholipid syndrome (APS) is a unique form of acquired autoimmune thrombophilia in which patients present with clinical features of recurrent thrombosis and pregnancy morbidity and persistently test positive for the presence of antiphospholipid antibodies (aPL). At least one clinical (vascular thrombosis or pregnancy morbidity) and one lab-based (positive test result for lupus anticoagulant, anticardiolipin antibodies and/or anti-β2-glycoprotein 1 antibodies) criterion have to be met for a patient to be classified as having APS. However, the clinical spectrum of APS encompasses additional manifestations that can affect many organs and cannot be explained exclusively by patients being in a prothrombotic state; clinical manifestations not listed in the classification criteria (known as extra-criteria manifestations) include neurologic manifestations (chorea, myelitis and migraine), haematologic manifestations (thrombocytopenia and haemolytic anaemia), livedo reticularis, nephropathy and valvular heart disease. Increasingly, research interest has focused on the development of novel assays that might be more specific for APS than the current aPL tests. This Review focuses on the current classification criteria for APS, presenting the role of extra-criteria manifestations and lab-based tests. Diagnostic approaches to difficult cases, including so-called seronegative APS, are also discussed.

  14. Accuracy of diagnosis criteria in patients with suspected diagnosis of sporadic Creutzfeldt-Jakob disease and detection of 14-3-3 protein, France, 1992 to 2009.

    Science.gov (United States)

    Peckeu, Laurene; Delasnerie-Lauprètre, Nicole; Brandel, Jean-Philippe; Salomon, Dominique; Sazdovitch, Véronique; Laplanche, Jean-Louis; Duyckaerts, Charles; Seilhean, Danielle; Haïk, Stéphane; Hauw, Jean-Jacques

    2017-10-01

    Diagnostic criteria of Creutzfeldt-Jakob disease (CJD), a rare and fatal transmissible nervous system disease with public health implications, are determined by clinical data, electroencephalogram (EEG), detection of 14-3-3 protein in cerebrospinal fluid (CSF), brain magnetic resonance imaging and prion protein gene examination. The specificity of protein 14-3-3 has been questioned. We reviewed data from 1,572 autopsied patients collected over an 18-year period (1992-2009) and assessed whether and how 14-3-3 detection impacted the diagnosis of sporadic CJD in France, and whether this led to the misdiagnosis of treatable disorders. 14-3-3 detection was introduced into diagnostic criteria for CJD in 1998. Diagnostic accuracy decreased from 92% for the 1992-1997 period to 85% for the 1998-2009 period. This was associated with positive detections of 14-3-3 in cases with negative EEG and alternative diagnosis at autopsy. Potentially treatable diseases were found in 163 patients (10.5%). This study confirms the usefulness of the recent modification of diagnosis criteria by the addition of the results of CSF real-time quaking-induced conversion, a method based on prion seed-induced misfolding and aggregation of recombinant prion protein substrate that has proven to be a highly specific test for diagnosis of sporadic CJD.

  15. Comparison of mania patients suitable for treatment trials versus clinical treatment.

    Science.gov (United States)

    Talamo, Alessandra; Baldessarini, Ross J; Centorrino, Franca

    2008-08-01

    It remains uncertain whether bipolar disorder (BPD) patients in randomized-controlled trials (RCTs) are sufficiently representative of clinically encountered patients as to guide clinical-therapeutic practice. We complied inclusion/exclusion criteria by frequency from reports of 21 RCTs for mania, and applied them in a pilot study of patients hospitalized for DSM-IV BPD manic/mixed states to compare characteristics and clinical responses of patients who did versus did not meet exclusion criteria. From 27 initially identified inclusion/exclusion criteria ranked by citation frequency, we derived six inclusion, and 10 non-redundant-exclusion factors. Of 67 consecutive patients meeting inclusion criteria, 15 (22.4%) potential "research subjects" met all 10 exclusion criteria. The remaining 52 "clinical patients" differed markedly on exclusion criteria, including more psychiatric co-morbidity, substance abuse, involuntary hospitalization, and suicide attempts or violence, but were otherwise similar. In both groups responses to clinically determined inpatient treatments were similar, including improvement in mania ratings. Based on applying reported inclusion/exclusion criteria for RCTs to a pilot sample of hospitalized-manic patients, those likely to be included in modern RCTs were similar to patients who would be excluded, most notably in short-term antimanic-treatment responses. The findings encourage further comparisons of subjects included/excluded from RCTs to test potential clinical generalizability of research findings. The pilot study is limited in numbers and exposure times with which to test for the minor differences between "research subjects" and "clinical patients." (c) 2008 John Wiley & Sons, Ltd.

  16. Application of strict criteria in adrenal venous sampling increases the proportion of missed patients with unilateral disease who benefit from surgery for primary aldosteronism.

    Science.gov (United States)

    Kline, Gregory; Leung, Alexander; So, Benny; Chin, Alex; Harvey, Adrian; Pasieka, Janice L

    2018-06-01

    Adrenal vein sampling (AVS) is intended to confirm unilateral forms of primary aldosteronism, which are amenable to surgical cure. Excessively strict AVS criteria to define lateralization may result in many patients incorrectly categorized as bilateral primary aldosteronism and opportunity for surgical cure missed. Retrospective review of an AVS-primary aldosteronism database in which surgical cases are verified by standardized outcomes. Having used 'less strict' AVS criteria for lateralization, we examined the distribution of AVS lateralization indices in our confirmed unilateral primary aldosteronism cases both with and without cosyntropin stimulation. The proportion of proven unilateral cases that would have been missed with stricter AVS interpretation criteria was calculated. Particular focus was given to the proportion of missed cases according to use of international guidelines. False-positive lateralization with 'less strict' interpretation was also calculated. Of 80 surgical primary aldosteronism cases, 10-23% would have been missed with AVS lateralization indices of 3 : 1 to 5 : 1, with or without cosyntropin. If strict selectivity indices (for confirmation of catheterization) were combined with strict lateralization indices, up to 70% of unilateral primary aldosteronism cases could have been missed. Use of Endocrine Society AVS guidelines would have missed 21-43% of proven unilateral cases. 'Less strict' AVS interpretation yielded one case (1.2%) of false lateralization. Excessively strict AVS interpretation criteria will result in a high rate of missed unilateral primary aldosteronism with subsequent loss of opportunity for intervention. Use of more lenient lateralization criteria will improve the detection rate of unilateral primary aldosteronism with very low false-positive rate.

  17. Adopting Clinical Guidelines for Admission Criteria of Intensive Care Unit: A Measure to Manage Queues of Patients Waiting for This Section

    Directory of Open Access Journals (Sweden)

    Afshin Mohammad Alizadeh

    2018-04-01

    Full Text Available Background: Due to the need of patients to the intensive care unit (ICU for receiving medical and nursing services, these services should be provided in a timely manner. This study aimed to develop the clinical guidelines for admission criteria of intensive care unit.Materials and Methods: This study was observational type study was conducted for nine months in 2015 based on a three-step process of adoption of clinical guidelines including planning, adoption and finalization. After conducting systematic searches, the quality of retrieved clinical guidelines was evaluated by experts from policy makers in the admission of patients in the ICU. Finally, the ultimate version of the guideline was developed after reviewing and organizing expert panel sessions.Results: The criteria for accepting patients were presented in form of seven clauses based on the neurological status, cardiovascular status, respiratory status, water and electrolyte disorders, gastrointestinal disturbances, endocrine disorders, surgery and postoperative care.Conclusion: One of the most important factors of creating demand inducing to the patients is the lack of clinical guidelines. It is recommended that departmental doctors should apply the mentioned clinical guidelines in order to make the resources of the intensive care unit more effective.

  18. Experience of exclusion

    DEFF Research Database (Denmark)

    Pedersen, Maria; Overgaard, Dorthe; Andersen, Ingelise

    2017-01-01

    -structured individual or dyadic interviews with patients (n = 24) and close relatives (n = 12). Informants were sampled from a quantitative prospective study of 302 patients with acute coronary syndrome and data were analyzed using the framework method. Results: Patients in different socioeconomic groups were...

  19. Patient-reported outcome measures for chronic obstructive pulmonary disease : the exclusion of people with low literacy skills and learning disabilities

    NARCIS (Netherlands)

    Jahagirdar, D.; Kroll, T.; Ritchie, K.; Wyke, S.

    2013-01-01

    BACKGROUND: Patient-reported outcome measures (PROMs) are intended to reflect outcomes relevant to patients. They are increasingly used for healthcare quality improvement. To produce valid measures, patients should be involved in the development process but it is unclear whether this usually

  20. Why do patients undergoing anterior cruciate ligament reconstruction in Brazil stay in hospital for longer periods than in other countries? Prospective evaluation of 30 patients and presentation of possible discharge criteria

    Directory of Open Access Journals (Sweden)

    Diego Costa Astur

    2013-08-01

    Full Text Available OBJECTIVE: Evaluate a better moment by the medical team and patient to be discharged and relate to possible medical discharge criteria. METHODS: 31 anterior cruciate ligament reconstructed patients under similar conditions prospectively evaluated about the possibility of discharge with 24 and 48 hours after surgery and possibles discharges criteria such as pain, range of motion and capacity quadriceps contraction, besides the use of a validated scale to measure the patient's functional independence. RESULTS: 50% and 6.4% of patients prefer remain hospitalized after 24 and 48 hours of surgery, respectively. The average of the visual analogue scale of pain was 2.63 and 1.76 points, and the range of motion of 79º and 86,7º after 24 and 48 hours, respectively. 100% of patients were able to quadriceps contraction in every evaluated moments. CONCLUSION: In Brazil, possible discharged criteria as pain, range of motion, quad contraction and motor independence motor function scale show that anterior cruciate reconstruction reconstructed patients could be discharged after 24 hours of surgery. However, 50% of patients still prefer to remain hospitalized for longer periods.

  1. High sensitivity and specificity in proposed clinical diagnostic criteria for anti-N-methyl-D-aspartate receptor encephalitis.

    Science.gov (United States)

    Ho, Alvin C C; Mohammad, Shekeeb S; Pillai, Sekhar C; Tantsis, Esther; Jones, Hannah; Ho, Reena; Lim, Ming; Hacohen, Yael; Vincent, Angela; Dale, Russell C

    2017-12-01

    To determine the validity of the proposed clinical diagnostic criteria for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis in paediatric patients. The diagnostic criteria for anti-NMDAR encephalitis proposed by Graus et al. (2016) use clinical features and conventional investigations to facilitate early immunotherapy before antibody status is available. The criteria are satisfied if patients develop four out of six symptom groups within 3 months, together with at least one abnormal investigation (electroencephalography/cerebrospinal fluid) and reasonable exclusion of other disorders. We evaluated the validity of the criteria using a retrospective cohort of paediatric patients with encephalitis. Twenty-nine patients with anti-NMDAR encephalitis and 74 comparison children with encephalitis were included. As expected, the percentage of patients with anti-NMDAR encephalitis who fulfilled the clinical criteria increased over time. During the hospital inpatient admission, most patients (26/29, 90%) with anti-NMDAR encephalitis fulfilled the criteria, significantly more than the comparison group (3/74, 4%) (panti-NMDAR encephalitis was 2 weeks from first symptom onset (range 1-6). The sensitivity of the criteria was 90% (95% confidence interval 73-98) and the specificity was 96% (95% confidence interval 89-99). The proposed diagnostic criteria for anti-NMDAR encephalitis have good sensitivity and specificity. Incomplete criteria do not exclude the diagnosis. The proposed clinical diagnostic criteria for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis by Graus et al. (2016) have high sensitivity and specificity in paediatric patients. The median time of fulfilling the criteria in patients with anti-NMDAR was 2 weeks from first symptom onset. © 2017 Mac Keith Press.

  2. Feasibility and acceptability of electronic symptom surveillance with clinician feedback using the Patient-Reported Outcomes version of Common Terminology Criteria for Adverse Events (PRO-CTCAE) in Danish prostate cancer patients

    DEFF Research Database (Denmark)

    Baeksted, Christina; Pappot, Helle; Nissen, Aase

    2017-01-01

    Background: The aim was to examine the feasibility, acceptability and clinical utility of electronic symptom surveillance with clinician feedback using a subset of items drawn from the Patient-Reported Outcomes version of Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a cancer...

  3. Assessing Decision Making Capacity for Do Not Resuscitate Requests in Depressed Patients: How to Apply the "Communication" and "Appreciation" Criteria.

    Science.gov (United States)

    Brody, Benjamin D; Meltzer, Ellen C; Feldman, Diana; Penzner, Julie B; Gordon-Elliot, Janna S

    2017-12-01

    The Patient Self Determination Act (PSDA) of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient's preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity (DMC). In general, patients are presumed to have DMC. A patient's DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders.

  4. Proposed Diagnostic Criteria for Smartphone Addiction.

    Science.gov (United States)

    Lin, Yu-Hsuan; Chiang, Chih-Lin; Lin, Po-Hsien; Chang, Li-Ren; Ko, Chih-Hung; Lee, Yang-Han; Lin, Sheng-Hsuan

    2016-01-01

    Global smartphone penetration has led to unprecedented addictive behaviors. The aims of this study are to develop diagnostic criteria of smartphone addiction and to examine the discriminative ability and the validity of the diagnostic criteria. We developed twelve candidate criteria for characteristic symptoms of smartphone addiction and four criteria for functional impairment caused by excessive smartphone use. The participants consisted of 281 college students. Each participant was systematically assessed for smartphone-using behaviors by psychiatrist's structured diagnostic interview. The sensitivity, specificity, and diagnostic accuracy of the candidate symptom criteria were analyzed with reference to the psychiatrists' clinical global impression. The optimal model selection with its cutoff point of the diagnostic criteria differentiating the smartphone addicted subjects from non-addicted subjects was then determined by the best diagnostic accuracy. Six symptom criteria model with optimal cutoff point were determined based on the maximal diagnostic accuracy. The proposed smartphone addiction diagnostic criteria consisted of (1) six symptom criteria, (2) four functional impairment criteria and (3) exclusion criteria. Setting three symptom criteria as the cutoff point resulted in the highest diagnostic accuracy (84.3%), while the sensitivity and specificity were 79.4% and 87.5%, respectively. We suggested determining the functional impairment by two or more of the four domains considering the high accessibility and penetration of smartphone use. The diagnostic criteria of smartphone addiction demonstrated the core symptoms "impaired control" paralleled with substance related and addictive disorders. The functional impairment involved multiple domains provide a strict standard for clinical assessment.

  5. Long term results of hypo-fractionated mammary radiotherapy as exclusive treatment of elderly patients suffering from a beast cancer; Resultats a long terme de la radiotherapie mammaire hypofractionnee comme traitement exclusif des patientes agees souffrant d'un cancer du sein

    Energy Technology Data Exchange (ETDEWEB)

    Chargari, C.; Kirova, Y.; Laki, F.; Savignoni, A.; Dorval, D.; Dendale, R.; Bollet, M.; Fourquet, A.; Campana, F. [Institut Curie, 75 - Paris (France)

    2010-10-15

    The author discuss the results obtained on 29 elderly patients exclusively treated between 1995 and 1999 by mammary irradiation (32.5 Gy) in 5 fractions over 5 weeks, and then with a lower additional irradiation (13 Gy) in two fractions. They discuss the efficiency of this hypo-fractionated radiotherapy without breast conserving surgery. Short communication

  6. Diagnostic Criteria

    Directory of Open Access Journals (Sweden)

    Narender P. Van Orshoven

    2010-01-01

    Full Text Available The aims of this study were to find out whether Postprandial hypotension (PPH occurs more frequently in patients admitted to a geriatric ward than in healthy elderly individuals, what the optimal interval between blood pressure measurements is in order to diagnose PPH and how often it is associated with symptoms.The result of this study indicates that PPH is present in a high number of frail elderly, but also in a few healthy older persons. Measuring blood pressure at least every 10 minutes for 60 minutes after breakfast will adequately diagnose PPH, defined as >20 mmHg systolic fall, in most patients. However with definition of PPH as >30 mmHg systolic fall, measuring blood pressure every 10 minutes will miss PPH in one of three patients. With the latter definition of PPH the presence of postprandial complaints is not associated with the existence of PPH.

  7. Exclusion of pregnant women from industry-sponsored clinical trials.

    Science.gov (United States)

    Shields, Kristine E; Lyerly, Anne Drapkin

    2013-11-01

    The lack of human data available to inform evidence-based treatment for illness during pregnancy has led to calls for greater inclusion of pregnant women in research, but the extent of their current representation is poorly characterized. Our objective was to measure the current exclusion of pregnant women from industry-sponsored clinical trials as a baseline for future comparison. We compiled data from studies enrolling women of childbearing potential posted on www.ClinicalTrials.gov between 1 October 2011 and 31 January 2012. The review was limited to open United States-based phase IV interventional studies sponsored by the pharmaceutical industry evaluating treatment of conditions that may be experienced by but are not limited to pregnant women and did not involve a medication classified as potentially teratogenic. If there was no mention of pregnancy in the inclusion or exclusion criteria, we contacted a study representative to confirm that pregnant women could be enrolled. Of 558 qualifying industry-sponsored studies, five (1%) were designed specifically for pregnant women. Of 367 phase IV clinical trials with verified inclusion and exclusion criteria, 348 (95%) excluded pregnant women and 19 (5%) did not. We found the exclusion of pregnant women from industry-sponsored clinical trials to be common practice. Moving beyond reflexive exclusion and developing thoughtful criteria for inclusion of pregnant women in clinical research would likely advance the evidence base to inform treatment decisions during pregnancy and lead to better health outcomes for women and children.

  8. Retrospective application of Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure criteria for the remote management of patients with cardiac resynchronisation therapy.

    Science.gov (United States)

    Brasca, Francesco Ma; Franzetti, Jessica; Rella, Valeria; Malfatto, Gabriella; Brambilla, Roberto; Facchini, Mario; Parati, Gianfranco; Perego, Giovanni B

    2017-05-01

    Aim The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure (PARTNERS HF) trial elaborated a multiparametric model for prediction of acute decompensation in advanced heart failure patients, based on periodical in office data download from cardiac resynchronisation devices. In this study, we evaluated the ability of the PARTNERS HF criteria to detect initial decompensation in a population of moderate heart failure patients under remote monitoring. Methods We retrospectively applied the PARTNERS HF criteria to 1860 transmissions from 104 patients (median follow up 21 months; range 1-67 months), who were enrolled in our programme of telemedicine after cardiac resynchronisation therapy. We tested the ability of a score based on these criteria to predict any acute clinical decompensation occurring in the 15 days following a transmission. Results In 441 cases, acute heart failure was diagnosed after the index transmission. The area under the curve (AUC) of the score for the diagnosis of acute decompensation was 0.752 (confidence interval (CI) 95% 0.728-0.777). The best score cut-off was consistent with the results of PARTNERS HF: with a score ≥2, sensitivity was 75% and specificity 68%. The odds ratio for events was 6.24 (CI 95% 4.90-7.95; p < 0.001). Conclusions When retrospectively applied to remote monitoring transmissions and arranged in a score, PARTNERS HF criteria could identify HF patients who subsequently developed acute decompensation. These results warrant prospective studies applying PARTNERS HF criteria to remote monitoring.

  9. Combining the IADPSG criteria with the WHO diagnostic criteria for ...

    African Journals Online (AJOL)

    The International Association of Diabetes in Pregnancy Study Group (IADPSG) and World Health ... Macrosomia or at least one adverse outcome were more likely in GDM patients who ... criteria for GDM in the ADA's more recent position statement.[18] .... at risk for postpartum type 2 DM;[27] the IADPSG criteria on the other ...

  10. Impact of glycemic control on the incidence of acute kidney injury in critically ill patients: a comparison of two strategies using the RIFLE criteria

    Directory of Open Access Journals (Sweden)

    José Raimundo Araújo de Azevedo

    2010-06-01

    Full Text Available OBJECTIVE: To compare the renal outcome in patients submitted to two different regimens of glycemic control, using the RIFLE criteria to define acute kidney injury. INTRODUCTION: The impact of intensive insulin therapy on renal function outcome is controversial. The lack of a criterion for AKI definition may play a role on that. METHODS: Included as the subjects were 228 randomly selected, critically ill patients engaged in intensive insulin therapyor in a carbohydrate-restrictive strategy. Renal outcome was evaluated through the comparison of the last RIFLE score obtained during the ICU stay and the RIFLE score at admission; the outcome was classified as favorable, stable or unfavorable. RESULTS: The two groups were comparable regarding demographic data. AKI developed in 52% of the patients and was associated with a higher mortality (39.4% compared with those who did not have AKI (8.2% (p60, acute kidney injury and hypoglycemia were risk factors for mortality. CONCLUSION: Intensive insulin therapy and a carbohydrate-restrictive strategy were comparable regarding the incidence of acute kidney injury evaluated using RIFLE criteria.

  11. Abnormal neural responses to social exclusion in schizophrenia.

    Directory of Open Access Journals (Sweden)

    Victoria B Gradin

    Full Text Available Social exclusion is an influential concept in politics, mental health and social psychology. Studies on healthy subjects have implicated the medial prefrontal cortex (mPFC, a region involved in emotional and social information processing, in neural responses to social exclusion. Impairments in social interactions are common in schizophrenia and are associated with reduced quality of life. Core symptoms such as delusions usually have a social content. However little is known about the neural underpinnings of social abnormalities. The aim of this study was to investigate the neural substrates of social exclusion in schizophrenia. Patients with schizophrenia and healthy controls underwent fMRI while participating in a popular social exclusion paradigm. This task involves passing a 'ball' between the participant and two cartoon representations of other subjects. The extent of social exclusion (ball not being passed to the participant was parametrically varied throughout the task. Replicating previous findings, increasing social exclusion activated the mPFC in controls. In contrast, patients with schizophrenia failed to modulate mPFC responses with increasing exclusion. Furthermore, the blunted response to exclusion correlated with increased severity of positive symptoms. These data support the hypothesis that the neural response to social exclusion differs in schizophrenia, highlighting the mPFC as a potential substrate of impaired social interactions.

  12. Exclusive use of alternative medicine as a positive choice

    DEFF Research Database (Denmark)

    Skovgaard, Lasse; Pedersen, Inge Kryger; Verhoef, Marja

    2014-01-01

    BACKGROUND: A survey of members of the Danish MS Society revealed that a minority of MS patients choose to forgo all types of conventional treatment and use complementary and alternative medicine (CAM) exclusively. A qualitative follow-up study was performed to elucidate the choice of exclusive C......-care practitioners, patient organizations, and health authorities within the MS field should be aware of possible changes in patients' attitudes toward both CAM and conventional treatment interventions....

  13. Lost criteria

    Directory of Open Access Journals (Sweden)

    Aleksandr Egorovich Manoylov

    2010-01-01

    Full Text Available Physicians have been found to be inadequately aware of the structure of the causes of headache, vertigo, and their clinical importance in patients with essential hypertension. Incorrect ideas lead to the unfounded application of diagnostic techniques for imaging the great arteries of the head and to extremely simplified approaches to treating cerebrovascular diseases as short-term courses of therapy with vasoactive and metabolic agents.

  14. Concordance between DSM-IV and DSM-5 criteria for delirium diagnosis in a pooled database of 768 prospectively evaluated patients using the delirium rating scale-revised-98

    NARCIS (Netherlands)

    Meagher, David J.; Morandi, Alessandro; Inouye, Sharon K.; Ely, Wes; Adamis, Dimitrios; Maclullich, Alasdair J.; Rudolph, James L.; Neufeld, Karin; Leonard, Maeve; Bellelli, Giuseppe; Davis, Daniel; Teodorczuk, Andrew; Kreisel, Stefan; Thomas, Christine; Hasemann, Wolfgang; Timmons, Suzanne; O'Regan, Niamh; Grover, Sandeep; Jabbar, Faiza; Cullen, Walter; Dunne, Colum; Kamholz, Barbara; van Munster, Barbara C.; de Rooij, Sophia E.; de Jonghe, Jos; Trzepacz, Paula T.

    2014-01-01

    The Diagnostic and Statistical Manual fifth edition (DSM-5) provides new criteria for delirium diagnosis. We examined delirium diagnosis using these new criteria compared with the Diagnostic and Statistical Manual fourth edition (DSM-IV) in a large dataset of patients assessed for delirium and

  15. Exclusive use of arterial grafts in coronary artery bypass operations for three-vessel disease : Use of both thoracic arteries and the gastroepiploic artery in 256 consecutive patients

    NARCIS (Netherlands)

    Grandjean, JG; Voors, AA; Boonstra, PW; denHeyer, P; Ebels, T

    1996-01-01

    Methods: From September 1989 to September 1994 we operated on a consecutive group of 256 patients with three-vessel disease in whom we used the right gastroepiploic artery together with both internal thoracic arteries, Vein grafts were not used in these patients, This population consisted of 233 men

  16. Prediction of a multiple sclerosis diagnosis in patients with clinically isolated syndrome using the 2016 MAGNIMS and 2010 McDonald criteria: a retrospective study.

    Science.gov (United States)

    Filippi, Massimo; Preziosa, Paolo; Meani, Alessandro; Ciccarelli, Olga; Mesaros, Sarlota; Rovira, Alex; Frederiksen, Jette; Enzinger, Christian; Barkhof, Frederik; Gasperini, Claudio; Brownlee, Wallace; Drulovic, Jelena; Montalban, Xavier; Cramer, Stig P; Pichler, Alexander; Hagens, Marloes; Ruggieri, Serena; Martinelli, Vittorio; Miszkiel, Katherine; Tintorè, Mar; Comi, Giancarlo; Dekker, Iris; Uitdehaag, Bernard; Dujmovic-Basuroski, Irena; Rocca, Maria A

    2018-02-01

    In 2016, the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) network proposed modifications to the MRI criteria to define dissemination in space (DIS) and time (DIT) for the diagnosis of multiple sclerosis in patients with clinically isolated syndrome (CIS). Changes to the DIS definition included removal of the distinction between symptomatic and asymptomatic lesions, increasing the number of lesions needed to define periventricular involvement to three, combining cortical and juxtacortical lesions, and inclusion of optic nerve evaluation. For DIT, removal of the distinction between symptomatic and asymptomatic lesions was suggested. We compared the performance of the 2010 McDonald and 2016 MAGNIMS criteria for multiple sclerosis diagnosis in a large multicentre cohort of patients with CIS to provide evidence to guide revisions of multiple sclerosis diagnostic criteria. Brain and spinal cord MRI and optic nerve assessments from patients with typical CIS suggestive of multiple sclerosis done less than 3 months from clinical onset in eight European multiple sclerosis centres were included in this retrospective study. Eligible patients were 16-60 years, and had a first CIS suggestive of CNS demyelination and typical of relapsing-remitting multiple sclerosis, a complete neurological examination, a baseline brain and spinal cord MRI scan obtained less than 3 months from clinical onset, and a follow-up brain scan obtained less than 12 months from CIS onset. We recorded occurrence of a second clinical attack (clinically definite multiple sclerosis) at months 36 and 60. We evaluated MRI criteria performance for DIS, DIT, and DIS plus DIT with a time-dependent receiver operating characteristic curve analysis. Between June 16, 1995, and Jan 27, 2017, 571 patients with CIS were screened, of whom 368 met all study inclusion criteria. At the last evaluation (median 50·0 months [IQR 27·0-78·4]), 189 (51%) of 368 patients developed clinically definite multiple

  17. Generalized exclusion and Hopf algebras

    International Nuclear Information System (INIS)

    Yildiz, A

    2002-01-01

    We propose a generalized oscillator algebra at the roots of unity with generalized exclusion and we investigate the braided Hopf structure. We find that there are two solutions: these are the generalized exclusions of the bosonic and fermionic types. We also discuss the covariance properties of these oscillators

  18. Evaluating Alternatives to Exclusive "He."

    Science.gov (United States)

    Todd-Mancillas, William R.

    A study was conducted to determine the effects on reading comprehension of the use of the exclusive pronoun "he" and more or less contrived alternatives. Subjects, 358 students enrolled in an introduction to human communication at a large northeastern university, read three different forms of the same essay. One essay form exclusively used "he,"…

  19. A delphi exercise to identify characteristic features of gout - opinions from patients and physicians, the first stage in developing new classification criteria.

    Science.gov (United States)

    Prowse, Rebecca L; Dalbeth, Nicola; Kavanaugh, Arthur; Adebajo, Adewale O; Gaffo, Angelo L; Terkeltaub, Robert; Mandell, Brian F; Suryana, Bagus P P; Goldenstein-Schainberg, Claudia; Diaz-Torne, Cèsar; Khanna, Dinesh; Lioté, Frederic; Mccarthy, Geraldine; Kerr, Gail S; Yamanaka, Hisashi; Janssens, Hein; Baraf, Herbert F; Chen, Jiunn-Horng; Vazquez-Mellado, Janitzia; Harrold, Leslie R; Stamp, Lisa K; Van De Laar, Mart A; Janssen, Matthijs; Doherty, Michael; Boers, Maarten; Edwards, N Lawrence; Gow, Peter; Chapman, Peter; Khanna, Puja; Helliwell, Philip S; Grainger, Rebecca; Schumacher, H Ralph; Neogi, Tuhina; Jansen, Tim L; Louthrenoo, Worawit; Sivera, Francisca; Taylor, William J; Alten, Rieke

    2013-04-01

    To identify a comprehensive list of features that might discriminate between gout and other rheumatic musculoskeletal conditions, to be used subsequently for a case-control study to develop and test new classification criteria for gout. Two Delphi exercises were conducted using Web-based questionnaires: one with physicians from several countries who had an interest in gout and one with patients from New Zealand who had gout. Physicians rated a list of potentially discriminating features that were identified by literature review and expert opinion, and patients rated a list of features that they generated themselves. Agreement was defined by the RAND/UCLA disagreement index. Forty-four experienced physicians and 9 patients responded to all iterations. For physicians, 71 items were identified by literature review and 15 more were suggested by physicians. The physician survey showed agreement for 26 discriminatory features and 15 as not discriminatory. The patients identified 46 features of gout, for which there was agreement on 25 items as being discriminatory and 7 items as not discriminatory. Patients and physicians agreed upon several key features of gout. Physicians emphasized objective findings, imaging, and patterns of symptoms, whereas patients emphasized severity, functional results, and idiographic perception of symptoms.

  20. [Quality of life or life expectancy? Criteria and sources of information in the decision-making of patients undergoing aortic valve surgery].

    Science.gov (United States)

    Schmied, Wolfram; Barnick, Saskia; Heimann, Dierk; Schäfers, Hans-Joachim; Köllner, Volker

    2015-01-01

    Physicians are expected to involve patients adequately in the decision-making process prior to surgery. To this end, it is essential to have knowledge about the potential reasons for such a decision. In this study we investigated which information sources and decision criteria are important to patients prior to aortic valve surgery. A consecutive sample of 468 patients (70.1%m, aged 66.9±14.2 years) was examined 2 years after aortic valve replacement or reconstruction with a self-developed questionnaire. Preoperative discussion with a cardiologist or a cardiac surgeon was the information source patients used most frequently and felt to be the most helpful. The most important decision criterion was quality of life, followed by life expectancy and likelihood of reoperation. Two years postoperatively, 97.3% of the patients were satisfied with their decision. Preoperative counseling by a physician plays an essential role in the decision-making process prior to cardiac surgery. Patients want to be involved in decision-making, though they do not want to bear the full responsibility.

  1. [Wells clinical prediction criteria in patients suspected of having deep vein thrombosis: evaluation of components and use in the emergency department].

    Science.gov (United States)

    García-Castrillo Riesgo, Luis; Jiménez Hernández, Sònia; Piñera Salmerón, Pascual

    2015-01-01

    To determine the applicability of the Wells clinical prediction criteria for deep vein thrombosis (DVT) in patients in hospital emergency departments and to evaluate the relevance of the score's components. Prospective multicenter cohort study in consecutive hospital emergency department patients suspected of having DVT. Full-leg Doppler compression ultrasound imaging was performed on all patients. We recorded information on variables related to risk for DVT and the components of clinical prediction scales. Wells and Oudega clinical prediction scores were calculated. We studied 362 patients in 23 hospital emergency departments; the mean (SD) age was 65 (18) years and 52.8% were women. DVT was diagnosed in 254 patients (70.16%); 171 (47.2%) had proximal DVT. The clinical probability of DVT according to the Wells scale and the prevalence of proximal DVT were as follows: low probability, 57 patients (14 with DVT, 24.6%); intermediate probability, 124 (43 with DVT, 34.7%), and high probability, 181 (114 with DVT, 63%). Only 5 of the components of the Wells scale were associated with the presence of proximal DVT. The prevalence of DVT is very high in the 3 categories of clinical probability indicated by the Wells score. The prevalences do not correspond to those of the cohort used to validate the scale. It appears to be necessary to develop scales adjusted for use in hospital emergency departments when DVT is suspected.

  2. Definition of insulin resistance using the homeostasis model assessment (HOMA-IR) in IVF patients diagnosed with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria.

    Science.gov (United States)

    Alebić, Miro Šimun; Bulum, Tomislav; Stojanović, Nataša; Duvnjak, Lea

    2014-11-01

    Polycystic ovary syndrome (PCOS) women are more insulin resistant than general population. Prevalence data on insulin resistance (IR) in PCOS vary depending on population characteristics and methodology used. The objectives of this study were to investigate whether IR in PCOS is exclusively associated with body mass and to assess the prevalence of IR in lean and overweight/obese PCOS. Study included 250 consecutive women who attended a Department of Human Reproduction diagnosed as having PCOS according to the Rotterdam criteria. Control group comprised 500 healthy women referred for male factor infertility evaluation during the same period as the PCOS women. PCOS women (n = 250) were more insulin resistant than controls (n = 500) even after adjustment for age and body mass index (BMI) (P = 0.03). Using logistic regression analysis, BMI ≥ 25 kg/m(2) (OR 6.0; 95 % CI 3.3-11.0), PCOS (OR 2.2; 95 % CI 1.4-3.5) and waist circumference ≥ 80 cm (OR 2.0; 95 % CI 1.1-3.8) were identified as independent determinants of IR (P IR was more prevalent in overweight/obese controls (n = 100) than in lean PCOS women (n = 150), 31 versus 9.3 %, but less prevalent than in overweight/obese PCOS (n = 100), 31 versus 57 %. The prevalence of IR between lean controls (5 %) and lean PCOS (9.3 %) did not significantly differ. Both PCOS-specific and obesity-related IR independently contribute to IR in PCOS. Using HOMA-IR cutoff value of 3.15 specific for Croatian women in our clinical setting, the assessed prevalence of IR in lean and overweight/obese PCOS women was 9.3 and 57 %, respectively.

  3. Equivalent 5-year bNED in select prostate cancer patients managed with surgery or radiation therapy despite exclusion of the seminal vesicles from the CTV

    International Nuclear Information System (INIS)

    D'amico, Anthony V.; Whittington, Richard; Kaplan, Irving; Beard, Clair; Schultz, Delray; Malkowicz, S. Bruce; Tomaszewski, John E.; Wein, Alan; Coleman, C. Norman

    1997-01-01

    Purpose: Prostate Specific Antigen (PSA) failure free survival was determined for select prostate cancer patients managed definitively with external beam radiation therapy to the prostate only or radical retropubic prostatectomy. Methods and Materials: A logistic regression multivariable analysis evaluating the variables of PSA, biopsy Gleason score, and clinical stage was used to evaluate the endpoint of pathologic seminal vesicle invasion (SVI) in 749 consecutive prostate cancer patients managed with a radical retropubic prostatectomy. In a subgroup of 332 surgically and 197 radiation managed patients who did not have the clinical predictors of SVI, PSA failure free survival (bNED) was determined. Comparisons were made using the log rank test between surgically and radiation managed patients in this subgroup. In this subgroup, radiation managed patients were treated to a median dose of 66 Gy (66-70 Gy) to the prostate only. Results: The pretreatment PSA (> 10 ng/ml), biopsy Gleason score (≥7), and clinical stage (T2b, 2c, or 3) were found to be significant independent predictors (p < 0.001) of SVI. Only 2% of patients without any of these factors had SVI and 17% had extracapsular extension (15% microscopic; 2% macroscopic). In this subgroup the 5-year bNED rates were equivalent [84 vs. 89% (p = 0.67)] for surgically and radiation managed patients, respectively. Conclusions: Conventional dose external beam radiation therapy directed at the prostate alone resulted in 5-year bNED rates equivalent to surgery on retrospective comparison in patients with clinical stage T1,2a, PSA ≤ 10 ng/ml, and biopsy Gleason ≤ 6 prostate cancer

  4. Hoarding symptoms are not exclusive to hoarders

    Directory of Open Access Journals (Sweden)

    Caterina Novara

    2016-11-01

    Full Text Available Hoarding Disorder (HD was originally conceptualized as a subcategory of Obsessive Compulsive Disorder (OCD, and numerous studies have in fact focused exclusively on investigating the comorbidity between OCD and HD. Hoarding behavior can nevertheless also be found in other clinical populations and in particular in patients with eating disorders (ED, anxiety disorders (AD, major depression (MD, and psychotic disorders (PD. The current study was carried out with the aim of investigating, using a validated instrument such as the Saving Inventory-Revised (SI-R, the presence of HD symptoms in patients diagnosed with ED, AD, MD and PD. Hoarding symptomatology was also assessed in groups of self-identified hoarders (SIH and healthy controls. The results revealed that 22.5% of the ED patients exceeded the cut-off for the diagnosis of HD, followed by 7.7% of the patients with MD, 7.4% of the patients with AD, and 5.9% of the patients with PD. The patients with ED had significantly higher SI-R scores than the other groups in the Acquisition and Difficulty Discarding scales while the AD, MD, and PD patients were characterized exclusively by Difficulty Discarding. These data suggest to clinicians that hoarding symptoms should be assessed in other types of patients and especially in those affected by Bulimia and Binge eating.

  5. An assessment of Prostate Cancer Research International: Active Surveillance (PRIAS) criteria for active surveillance of clinically low-risk prostate cancer patients

    Science.gov (United States)

    da Silva, Vitor; Cagiannos, Ilias; Lavallée, Luke T.; Mallick, Ranjeeta; Witiuk, Kelsey; Cnossen, Sonya; Eastham, James A.; Fergusson, Dean A.; Morash, Chris; Breau, Rodney H.

    2017-01-01

    Introduction Active surveillance is a strategy to delay or prevent treatment of indolent prostate cancer. The Prostate Cancer Research International: Active Surveillance (PRIAS) criteria were developed to select patients for prostate cancer active surveillance. The objective of this study was to compare pathological findings from PRIAS-eligible and PRIAS-ineligible clinically low-risk prostate cancer patients. Methods A D’Amico low-risk cohort of 1512 radical prostatectomy patients treated at The Ottawa Hospital or Memorial Sloan Kettering Cancer Centre between January 1995 and December 2007 was reviewed. Pathological outcomes (pT3 tumours, Gleason sum ≥7, lymph node metastases, or a composite) and clinical outcomes (prostate-specific antigen [PSA] recurrence, secondary cancer treatments, and death) were compared between PRIAS-eligible and PRIAS-ineligible cohorts. Results The PRIAS-eligible cohort (n=945) was less likely to have Gleason score ≥7 (odds ratio [OR] 0.61; 95% confidence interval [CI] 0.49–0.75), pT3 (OR 0.41; 95% CI 0.31–0.55), nodal metastases (OR 0.37; 95% CI 0.10–1.31), or any adverse feature (OR 0.56; 95% CI 0.45–0.69) compared to the PRIAS-ineligible cohort. The probability of any adverse pathology in the PRIAS-eligible cohort was 41% vs. 56% in the PRIAS-ineligible cohort. At median follow-up of 3.7 years, 72 (4.8%) patients had a PSA recurrence, 24 (1.6%) received pelvic radiation, and 13 (0.9%) received androgen deprivation. No difference was detected for recurrence-free and overall survival between groups (recurrence hazard ratio [HR] 0.71; 95% CI 0.46–1.09 and survival HR 0.72; 95% CI 0.36–1.47). Conclusions Low-risk prostate cancer patients who met PRIAS eligibility criteria are less likely to have higher-risk cancer compared to those who did not meet at least one of these criteria. PMID:28798822

  6. Structure of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Criteria for Obsessive–Compulsive Personality Disorder in Patients With Binge Eating Disorder

    Science.gov (United States)

    Ansell, Emily B; Pinto, Anthony; Edelen, Maria Orlando; Grilo, Carlos M

    2013-01-01

    Objective To examine 1-, 2-, and 3-factor model structures through confirmatory analytic procedures for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) obsessive–compulsive personality disorder (OCPD) criteria in patients with binge eating disorder (BED). Method Participants were consecutive outpatients (n = 263) with binge eating disorder and were assessed with semi-structured interviews. The 8 OCPD criteria were submitted to confirmatory factor analyses in Mplus Version 4.2 (Los Angeles, CA) in which previously identified factor models of OCPD were compared for fit, theoretical relevance, and parsimony. Nested models were compared for significant improvements in model fit. Results Evaluation of indices of fit in combination with theoretical considerations suggest a multifactorial model is a significant improvement in fit over the current DSM-IV single-factor model of OCPD. Though the data support both 2- and 3-factor models, the 3-factor model is hindered by an underspecified third factor. Conclusion A multifactorial model of OCPD incorporating the factors perfectionism and rigidity represents the best compromise of fit and theory in modelling the structure of OCPD in patients with BED. A third factor representing miserliness may be relevant in BED populations but needs further development. The perfectionism and rigidity factors may represent distinct intrapersonal and interpersonal attempts at control and may have implications for the assessment of OCPD. PMID:19087485

  7. Structure of diagnostic and statistical manual of mental disorders, fourth edition criteria for obsessive-compulsive personality disorder in patients with binge eating disorder.

    Science.gov (United States)

    Ansell, Emily B; Pinto, Anthony; Edelen, Maria Orlando; Grilo, Carlos M

    2008-12-01

    To examine 1-, 2-, and 3-factor model structures through confirmatory analytic procedures for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) obsessive-compulsive personality disorder (OCPD) criteria in patients with binge eating disorder (BED). Participants were consecutive outpatients (n = 263) with binge eating disorder and were assessed with semi-structured interviews. The 8 OCPD criteria were submitted to confirmatory factor analyses in Mplus Version 4.2 (Los Angeles, CA) in which previously identified factor models of OCPD were compared for fit, theoretical relevance, and parsimony. Nested models were compared for significant improvements in model fit. Evaluation of indices of fit in combination with theoretical considerations suggest a multifactorial model is a significant improvement in fit over the current DSM-IV single- factor model of OCPD. Though the data support both 2- and 3-factor models, the 3-factor model is hindered by an underspecified third factor. A multifactorial model of OCPD incorporating the factors perfectionism and rigidity represents the best compromise of fit and theory in modelling the structure of OCPD in patients with BED. A third factor representing miserliness may be relevant in BED populations but needs further development. The perfectionism and rigidity factors may represent distinct intrapersonal and interpersonal attempts at control and may have implications for the assessment of OCPD.

  8. Proposed diagnostic criteria for internet addiction.

    Science.gov (United States)

    Tao, Ran; Huang, Xiuqin; Wang, Jinan; Zhang, Huimin; Zhang, Ying; Li, Mengchen

    2010-03-01

    The objective of this study was to develop diagnostic criteria for internet addiction disorder (IAD) and to evaluate the validity of our proposed diagnostic criteria for discriminating non-dependent from dependent internet use in the general population. This study was conducted in three stages: the developmental stage (110 subjects in the survey group; 408 subjects in the training group), where items of the proposed diagnostic criteria were developed and tested; the validation stage (n = 405), where the proposed criteria were evaluated for criterion-related validity; and the clinical stage (n = 150), where the criteria and the global clinical impression of IAD were evaluated by more than one psychiatrist to determine inter-rater reliability. The proposed internet addiction diagnostic criteria consisted of symptom criterion (seven clinical symptoms of IAD), clinically significant impairment criterion (functional and psychosocial impairments), course criterion (duration of addiction lasting at least 3 months, with at least 6 hours of non-essential internet usage per day) and exclusion criterion (exclusion of dependency attributed to psychotic disorders). A diagnostic score of 2 + 1, where the first two symptoms (preoccupation and withdrawal symptoms) and at least one of the five other symptoms (tolerance, lack of control, continued excessive use despite knowledge of negative effects/affects, loss of interests excluding internet, and use of the internet to escape or relieve a dysphoric mood) was established. Inter-rater reliability was 98%. Our findings suggest that the proposed diagnostic criteria may be useful for the standardization of diagnostic criteria for IAD.

  9. 27 CFR 8.54 - Criteria for determining retailer independence.

    Science.gov (United States)

    2010-04-01

    ... TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS EXCLUSIVE OUTLETS Exclusion § 8.54 Criteria for... purchase or the quantity in which to purchase them for sale to consumers. (b) The industry member obligates the retailer to participate in the promotion to obtain the industry member's product. (c) The retailer...

  10. MLH1 constitutional and somatic methylation in patients with MLH1 negative tumors fulfilling the revised Bethesda criteria.

    Science.gov (United States)

    Crucianelli, Francesca; Tricarico, Rossella; Turchetti, Daniela; Gorelli, Greta; Gensini, Francesca; Sestini, Roberta; Giunti, Laura; Pedroni, Monica; Ponz de Leon, Maurizio; Civitelli, Serenella; Genuardi, Maurizio

    2014-10-01

    Lynch syndrome (LS) is a tumor predisposing condition caused by constitutional defects in genes coding for components of the mismatch repair (MMR) apparatus. While hypermethylation of the promoter of the MMR gene MLH1 occurs in about 15% of colorectal cancer samples, it has also been observed as a constitutional alteration, in the absence of DNA sequence mutations, in a small number of LS patients. In order to obtain further insights on the phenotypic characteristics of MLH1 epimutation carriers, we investigated the somatic and constitutional MLH1 methylation status of 14 unrelated subjects with a suspicion of LS who were negative for MMR gene constitutional mutations and whose tumors did not express the MLH1 protein. A novel case of constitutional MLH1 epimutation was identified. This patient was affected with multiple primary tumors, including breast cancer, diagnosed starting from the age of 55 y. Investigation of her offspring by allele specific expression revealed that the epimutation was not stable across generations. We also found MLH1 hypermethylation in cancer samples from 4 additional patients who did not have evidence of constitutional defects. These patients had some characteristics of LS, namely early age at onset and/or positive family history, raising the possibility of genetic influences in the establishment of somatic MLH1 methylation.

  11. Early response to sibutramine in patients not meeting current label criteria: preliminary analysis of SCOUT lead-in period

    DEFF Research Database (Denmark)

    Caterson, Ian; Coutinho, Walmir; Finer, Nick

    2010-01-01

    pulse rate increases; median 1.5 bpm (nonconformers) vs. 3.0 bpm (conformers). There was a low incidence of serious adverse events (conformers: 1.0%; nonconformers: 2.8%) and ~93% of patients in both groups completed the 6-week period. The SCOUT lead-in period evaluating weight management...

  12. Concordance between DSM-IV and DSM-5 criteria for delirium diagnosis in a pooled database of 768 prospectively evaluated patients using the delirium rating scale-revised-98

    OpenAIRE

    Meagher, David J; Morandi, Alessandro; Inouye, Sharon K; Ely, Wes; Adamis, Dimitrios; Maclullich, Alasdair J; Rudolph, James L; Neufeld, Karin; Leonard, Maeve; Bellelli, Giuseppe; Davis, Daniel; Teodorczuk, Andrew; Kriesel, Stefan; Thomas, Christine; Hasemann, Wolfgang

    2014-01-01

    peer-reviewed Background: The Diagnostic and Statistical Manual fifth edition (DSM-5) provides new criteria for delirium diagnosis. We examined delirium diagnosis using these new criteria compared with the Diagnostic and Statistical Manual fourth edition (DSM-IV) in a large dataset of patients assessed for delirium and related presentations. Methods: Patient data (n = 768) from six prospectively collected cohorts, clinically assessed using DSM-IV and the Delirium Rating Scale-R...

  13. Standardizing the evaluation criteria on treatment outcomes of mandibular implant overdentures: a systematic review

    Science.gov (United States)

    Kim, Ha-Young; Shin, Sang-Wan

    2014-01-01

    PURPOSE The aim of this review was to analyze the evaluation criteria on mandibular implant overdentures through a systematic review and suggest standardized evaluation criteria. MATERIALS AND METHODS A systematic literature search was conducted by PubMed search strategy and hand-searching of relevant journals from included studies considering inclusion and exclusion criteria. Randomized clinical trials (RCT) and clinical trial studies comparing attachment systems on mandibular implant overdentures until December, 2011 were selected. Twenty nine studies were finally selected and the data about evaluation methods were collected. RESULTS Evaluation criteria could be classified into 4 groups (implant survival, peri-implant tissue evaluation, prosthetic evaluation, and patient satisfaction). Among 29 studies, 21 studies presented implant survival rate, while any studies reporting implant failure did not present cumulative implant survival rate. Seventeen studies evaluating peri-implant tissue status presented following items as evaluation criteria; marginal bone level (14), plaque Index (13), probing depth (8), bleeding index (8), attachment gingiva level (8), gingival index (6), amount of keratinized gingiva (1). Eighteen studies evaluating prosthetic maintenance and complication also presented following items as evaluation criteria; loose matrix (17), female detachment (15), denture fracture (15), denture relining (14), abutment fracture (14), abutment screw loosening (11), and occlusal adjustment (9). Atypical questionnaire (9), Visual analog scales (VAS) (4), and Oral Health Impact Profile (OHIP) (1) were used as the format of criteria to evaluate patients satisfaction in 14 studies. CONCLUSION For evaluation of implant overdenture, it is necessary to include cumulative survival rate for implant evaluation. It is suggested that peri-implant tissue evaluation criteria include marginal bone level, plaque index, bleeding index, probing depth, and attached gingiva

  14. Exclusion of the GNAS locus in PHP-Ib patients with broad GNAS methylation changes: evidence for an autosomal recessive form of PHP-Ib?

    Science.gov (United States)

    Fernández-Rebollo, Eduardo; Pérez de Nanclares, Guiomar; Lecumberri, Beatriz; Turan, Serap; Anda, Emma; Pérez-Nanclares, Gustavo; Feig, Denice; Nik-Zainal, Serena; Bastepe, Murat; Jüppner, Harald

    2011-08-01

    Most patients with autosomal dominant pseudohypoparathyroidism type Ib (AD-PHP-Ib) carry maternally inherited microdeletions upstream of GNAS that are associated with loss of methylation restricted to GNAS exon A/B. Only few AD-PHP-Ib patients carry microdeletions within GNAS that are associated with loss of all maternal methylation imprints. These epigenetic changes are often indistinguishable from those observed in patients affected by an apparently sporadic PHP-Ib form that has not yet been defined genetically. We have now investigated six female patients affected by PHP-Ib (four unrelated and two sisters) with complete or almost complete loss of GNAS methylation, whose healthy children (11 in total) showed no epigenetic changes at this locus. Analysis of several microsatellite markers throughout the 20q13 region made it unlikely that PHP-Ib is caused in these patients by large deletions involving GNAS or by paternal uniparental isodisomy or heterodisomy of chromosome 20 (patUPD20). Microsatellite and single-nucleotide variation (SNV) data revealed that the two affected sisters share their maternally inherited GNAS alleles with unaffected relatives that lack evidence for abnormal GNAS methylation, thus excluding linkage to this locus. Consistent with these findings, healthy children of two unrelated sporadic PHP-Ib patients had inherited different maternal GNAS alleles, also arguing against linkage to this locus. Based on our data, it appears plausible that some forms of PHP-Ib are caused by homozygous or compound heterozygous mutation(s) in an unknown gene involved in establishing or maintaining GNAS methylation. Copyright © 2011 American Society for Bone and Mineral Research.

  15. Towards Tailored Patient’s Management Approach: Integrating the Modified 2010 ACR Criteria for Fibromyalgia in Multidimensional Patient Reported Outcome Measures Questionnaire

    Directory of Open Access Journals (Sweden)

    Yasser El Miedany

    2016-01-01

    Full Text Available Objectives. To assess the validity, reliability, and responsiveness to change of a patient self-reported questionnaire combining the Widespread Pain Index and the Symptom Severity Score as well as construct outcome measures and comorbidities assessment in fibromyalgia patients. Methods. The PROMs-FM was conceptualized based on frameworks used by the WHO Quality of Life tool and the PROMIS. Initially, cognitive interviews were conducted to identify item pool of questions. Item selection and reduction were achieved based on patients as well as an interdisciplinary group of specialists. Rasch and internal consistency reliability analyses were implemented. The questionnaire included the modified ACR criteria main items (Symptom Severity Score and Widespread Pain Index, in addition to assessment of functional disability, quality of life (QoL, review of the systems, and comorbidities. Every patient completed HAQ and EQ-5D questionnaires. Results. A total of 146 fibromyalgia patients completed the questionnaire. The PROMs-FM questionnaire was reliable as demonstrated by a high standardized alpha (0.886–0.982. Content construct assessment of the functional disability and QoL revealed significant correlation (p<0.01 with both HAQ and EQ-5D. Changes in functional disability and QoL showed significant (p<0.01 variation with diseases activity status in response to therapy. There was higher prevalence of autonomic symptoms, CVS risk, sexual dysfunction, and falling. Conclusions. The developed PROMs-FM questionnaire is a reliable and valid instrument for assessment of fibromyalgia patients. A phased treatment regimen depending on the severity of FMS as well as preferences and comorbidities of the patient is the best approach to tailored patient management.

  16. Assessment of cardiovascular risk and target organ damage among adult patients with primary hypertension in Thika Level 5 Hospital, Kenya: a criteria-based clinical audit.

    Science.gov (United States)

    Mwita, Clifford Chacha; Akello, Walter; Sisenda, Gloria; Ogoti, Evans; Tivey, David; Munn, Zachary; Mbogo, David

    2013-06-01

    Appropriate management of hypertension reduces the risk of death from stroke and cardiac disease and includes routine assessment for target organ damage and estimation of cardiovascular risk. However, implementation of evidence-based hypertension management guidelines is unsatisfactory. We explore the use of audit and feedback as a quality improvement (QI) strategy for reducing the knowledge practice gap in hypertension care in a resource poor setting. The aim of this study is to determine the level of compliance to evidence-based guidelines on assessment of cardiovascular risk and target organ damage among patients with hypertension in Thika Level 5 Hospital in central Kenya and to implement best practice with regard to evidence utilisation among clinicians in the hospital. A retrospective clinical audit done in three phases spread over 5 months. Phase one involved identifying five audit criteria on assessment of cardiovascular risk and target organ damage in patients with hypertension and conducting a baseline audit in which compliance to audit criteria, blood pressure control and drug prescription practices were assessed. Phase two involved identifying barriers to compliance to audit criteria and strategies to overcoming these barriers. The third phase was a follow-up audit. There was no use of a cardiovascular risk assessment tool in both audits (0% vs. 0%; P = 1.00). Testing urine for haematuria and proteinuria reduced from 13% to 8% (P = 0.230) while taking a blood sample for measuring blood glucose, electrolytes and creatinine levels improved from 11% to 17% (P = 0.401). Performance of fundoscopy and electrocardiography remained unchanged at 2% and 8%, respectively (P = 0.886 and P = 0.898). High patient load was identified as the biggest barrier to implementation of best practice. Blood pressure control improved from 33% to 70% (P ≤ 0.001), whereas the proportion of patients on two or more recommended antihypertensive drugs rose

  17. Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis

    Directory of Open Access Journals (Sweden)

    Doucet Jean

    2008-01-01

    Full Text Available Abstract Background There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP. Methods The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments – Urology (U, Infectious Diseases (ID, Internal Medicine (IM, Geriatrics (G – of two French university hospitals. Results The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen. Overall, a 3:1 ratio of community-acquired AP (CA-AP to nosocomial AP (N-AP was observed. Urine culture isolated mainly E. coli (58% of AP, 68% of CA-AP, with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen. For N-AP, these treatments were more likely to be inadequate (42% vs. 8%, p vs. 19%, p Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p Conclusion This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.

  18. Analysis of the relationships between oxidative stress, DNA damage and sperm vitality in a patient population: development of diagnostic criteria.

    Science.gov (United States)

    Aitken, R John; De Iuliis, Geoffry N; Finnie, Jane M; Hedges, Andrew; McLachlan, Robert I

    2010-10-01

    DNA damage in human spermatozoa is known to be associated with a variety of adverse clinical outcomes affecting both reproductive efficiency and the health and wellbeing of the offspring. However, the origin of this damage, its biochemical nature and strategies for its amelioration, still await resolution. Using novel methods to simultaneously assess DNA fragmentation (modified TUNEL assay), DNA-base adduct formation (8-hydroxy-2'-deoxyguanosine [8OHdG]) and cell vitality, spermatozoa from a cohort of 50 assisted conception patients were examined and compared with a group of donors. Receiver operating characteristic (ROC) curve analysis was then used to examine the frequency distribution of the data and to determine optimized thresholds for identifying patients exhibiting abnormally high levels of DNA damage. 8OHdG formation and DNA fragmentation were highly correlated with each other and frequently associated with cell death. Percoll centrifugation improved sperm quality but, unexpectedly, increased 8OHdG formation in live cells, as did sperm fractionation using Puresperm gradients. ROC analysis indicated that the frequency distribution of 8OHdG and DNA fragmentation data were significantly different between patients and donors (P live cells. However, the development of novel methods and optimized thresholds for diagnosing oxidative DNA damage in human spermatozoa should assist in the clinical management of this pathology.

  19. Defining criteria to choose appropriate destination hospital for trauma patients: Piacenza Local Health Authority’s Piacenza trauma algorithm protocol

    Directory of Open Access Journals (Sweden)

    Fabio Mozzarelli

    2016-04-01

    Full Text Available Ambulance crew’s choosing of appropriate destination hospital for trauma patients can affect survival and morbidity outcomes. Aim of the present study is to devise a decision-making algorithm in order to allow the best choice of destination hospital for trauma patients and to apply it on an electronic device able to facilitate the decision made by ambulance staff. The method used was analysis of literature data, context and workload with a retrospective observational study. A comparison between the destination hospitals actually chosen and those that could have been chosen with the Piacenza trauma algorithm has been applied. The data shows a 9.5% (P>0.10 more advantageous change in appropriateness in the choice of medical facility and a 1.4% increase in admissions to the Emergency Department of the provincial hospital. The creation and use of a medical protocol and its consequent installation on an electronic device (tablet that can be shared over a computer platform could help medical staff make appropriate pre-hospital choices as regards the destination hospital for trauma patients.

  20. Equivalent 5 year bNED in select prostate cancer patients managed with surgery or radiation therapy despite exclusion of the seminal vesicles from the clinical target volume

    International Nuclear Information System (INIS)

    D'Amico, A. V.; Whittington, R.; Kaplan, I.; Beard, C.; Schultz, D.; Malkowicz, S.B.; Tomaszewski, J.E.; Wein, A.; Coleman, C.N.

    1997-01-01

    Purpose: Prostate Specific Antigen (PSA) failure free survival was determined for select prostate cancer patients treated definitively with external beam radiation therapy to the prostate only or a radical retropubic prostatectomy. Materials and Methods: A logistic regression multivariable analysis evaluating the variables of PSA, biopsy Gleason score, and clinical stage was used to evaluate the endpoint of pathologic seminal vesicle invasion (SVI) in 749 consecutive prostate cancer patients treated with a radical retropubic prostatectomy. In a subgroup of 325 surgically and 197 radiation managed patients who did not have the clinical predictors of SVI, PSA failure free survival (bNED) was determined. Comparisons were made using the log rank test. Radiation managed patients in this subgroup were treated to a median dose of 66 Gray (66 - 70 Gray) in 2 Gray fractions to the prostate only. A 95% normalization was used routinely. Results: The pre-treatment PSA (> 10 ng/ml), biopsy Gleason score (≥ 7), and clinical stage (T 2b,2c,3 versus T 1,2a ) were found to be significant independent predictors (p 1,2a , PSA < 10 ng/ml, and biopsy Gleason ≤ 6 prostate cancer

  1. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial.

    Science.gov (United States)

    Freund, Yonathan; Cachanado, Marine; Aubry, Adeline; Orsini, Charlotte; Raynal, Pierre-Alexis; Féral-Pierssens, Anne-Laure; Charpentier, Sandrine; Dumas, Florence; Baarir, Nacera; Truchot, Jennifer; Desmettre, Thibaut; Tazarourte, Karim; Beaune, Sebastien; Leleu, Agathe; Khellaf, Mehdi; Wargon, Mathias; Bloom, Ben; Rousseau, Alexandra; Simon, Tabassome; Riou, Bruno

    2018-02-13

    The safety of the pulmonary embolism rule-out criteria (PERC), an 8-item block of clinical criteria aimed at ruling out pulmonary embolism (PE), has not been assessed in a randomized clinical trial. To prospectively validate the safety of a PERC-based strategy to rule out PE. A crossover cluster-randomized clinical noninferiority trial in 14 emergency departments in France. Patients with a low gestalt clinical probability of PE were included from August 2015 to September 2016, and followed up until December 2016. Each center was randomized for the sequence of intervention periods. In the PERC period, the diagnosis of PE was excluded with no further testing if all 8 items of the PERC rule were negative. The primary end point was the occurrence of a thromboembolic event during the 3-month follow-up period that was not initially diagnosed. The noninferiority margin was set at 1.5%. Secondary end points included the rate of computed tomographic pulmonary angiography (CTPA), median length of stay in the emergency department, and rate of hospital admission. Among 1916 patients who were cluster-randomized (mean age 44 years, 980 [51%] women), 962 were assigned to the PERC group and 954 were assigned to the control group. A total of 1749 patients completed the trial. A PE was diagnosed at initial presentation in 26 patients in the control group (2.7%) vs 14 (1.5%) in the PERC group (difference, 1.3% [95% CI, -0.1% to 2.7%]; P = .052). One PE (0.1%) was diagnosed during follow-up in the PERC group vs none in the control group (difference, 0.1% [95% CI, -∞ to 0.8%]). The proportion of patients undergoing CTPA in the PERC group vs control group was 13% vs 23% (difference, -10% [95% CI, -13% to -6%]; P < .001). In the PERC group, rates were significantly reduced for the median length of emergency department stay (mean reduction, 36 minutes [95% CI, 4 to 68]) and hospital admission (difference, 3.3% [95% CI, 0.1% to 6.6%]). Among very low-risk patients with suspected

  2. Problems of Chernobyl Exclusion Zone

    International Nuclear Information System (INIS)

    Kholosha, V.Yi.

    2014-01-01

    The collection comprises the results of researches and design activity in the ChNPP exclusion zone, aimed at the development of technologies, equipment and devices for radioactive waste management and ChNPP accident clean-up, at studying the composition and structure of the Exclusion zone soil activity solid bearers, form transformation of the fission products of fuel fallout radionuclide composition in the ChNPP near zone, the spatial distribution of radionuclides and other radioecological issues.. Much attention is paid to medical and biological aspects of the accident influence on the flora, fauna and people's health, labour conditions and incidence of the workers of the Exclusion zone

  3. Body mass index was associated with upstaging and upgrading in patients with low-risk prostate cancer who met the inclusion criteria for active surveillance.

    Science.gov (United States)

    de Cobelli, Ottavio; Terracciano, Daniela; Tagliabue, Elena; Raimondi, Sara; Galasso, Giacomo; Cioffi, Antonio; Cordima, Giovanni; Musi, Gennaro; Damiano, Rocco; Cantiello, Francesco; Detti, Serena; Victor Matei, Deliu; Bottero, Danilo; Renne, Giuseppe; Ferro, Matteo

    2015-05-01

    Obesity is associated with an increased risk of high-grade prostate cancer (PCa). The effect of body mass index (BMI) as a predictor of progression in men with low-risk PCa has been only poorly assessed. In this study, we evaluated the association of BMI with progression in patients with low-risk PCa who met the inclusion criteria for the active surveillance (AS) protocol. We assessed 311 patients who underwent radical prostatectomy and were eligible for AS according to the following criteria: clinical stage T2a or less, prostate-specific antigen level pT2) and upgraded (Gleason score ≥ 7; primary Gleason pattern 4) disease. Seminal vesicle invasion, positive lymph nodes, and tumor volume ≥ 0.5 ml were also recorded. We found that high BMI was significantly associated with upgrading, upstaging, and seminal vesicle invasion, whereas it was not associated with positive lymph nodes or large tumor volume. At multivariate analysis, 1 unit increase of BMI significantly increased the risk of upgrading, upstaging, seminal vesicle invasion, and any outcome by 21%, 23%, 27%, and 20%, respectively. The differences between areas under the receiver operating characteristics curves comparing models with and without BMI were statistically significant for upgrading (P = 0.0002), upstaging (P = 0.0007), and any outcome (P = 0.0001). BMI should be a selection criterion for inclusion of patients with low-risk PCa in AS programs. Our results support the idea that obesity is associated with worse prognosis and suggest that a close AS program is an appropriate treatment option for obese subjects. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Evaluation of proposed casemix criteria as a basis for costing patients in the adult general intensive care unit.

    Science.gov (United States)

    Stevens, V G; Hibbert, C L; Edbrooke, D L

    1998-10-01

    This study analyses the relationship between the actual patient-related costs of care calculated for 145 patients admitted sequentially to an adult general intensive care unit and a number of factors obtained from a previously described consensus of opinion study. The factors identified in the study were suggested as potential descriptors for the casemix in an intensive care unit that could be used to predict the costs of care. Significant correlations between the costs of care and severity of illness, workload and length of stay were found but these failed to predict the costs of care with sufficient accuracy to be used in isolation to define isoresource groups in the intensive care unit. No associations between intensive care unit mortality, reason for admission and intensive and unit treatments and costs of care were found. Based on these results, it seems that casemix descriptors and isoresource groups for the intensive care unit that would allow costs to be predicted cannot be defined in terms of single factors.

  5. Exclusive Rights and State Aid

    DEFF Research Database (Denmark)

    Ølykke, Grith Skovgaard

    2017-01-01

    Exclusive rights are granted in order to regulate markets as one of several possible tools of public intervention. The article considers the role of State aid law in the regulation of exclusive rights. Whereas the right of Member States to organise markets as monopolies and the choice of provider...... are regulated by free movement rules and Article 106 TFEU, State aid law regulates the terms of the right to ensure that the beneficiary is not granted an economic advantage. Exclusive rights may be granted on various terms: for a payment, in combination with compensation or as compensation. The two former...... kinds of terms are regulated under State aid law which requires market terms. The granting of exclusive rights as compensation is analysed on the basis of the Eventech judgment, and it is found that when no financial transaction is included in the grant, it resembles a decision to organise a market...

  6. Exclusive processes at Jefferson Lab

    Indian Academy of Sciences (India)

    There is no clear guidance from theory as to the limits of the transition region; .... behavior in exclusive photoreactions with hadrons in the final state at large t may provide .... The planned medium acceptance detector (MAD) system in Hall A.

  7. Central Exclusive Production at LHCb

    CERN Document Server

    INSPIRE-00106463

    2015-01-01

    Central Exclusive Production is a unique QCD process in which particles are produced via colourless propagators. Several results have been obtained at LHCb for the production of single charmonia, pairs of charmonia, and single bottomonia.

  8. Central Exclusive Production at LHCb

    CERN Document Server

    AUTHOR|(INSPIRE)INSPIRE-00392425

    2017-01-01

    The LHCb detector, with its excellent momentum resolution and flexible trigger strategy, is ideally suited for measuring particles produced exclusively. In addition, a new system of forward shower counters has been installed upstream and downstream of the detector, and has been used to facilitate studies of Central Exclusive Production. Such measurements of integrated and differential cross-section in both Run 1 and Run 2 of the LHC, are summarised here.

  9. Exclusive Territories and Manufacturers’ Collusion

    OpenAIRE

    Salvatore Piccolo; Markus Reisinger

    2010-01-01

    This paper highlights the rationale for exclusive territories in a model of repeated interaction between competing supply chains. We show that with observable contracts exclusive territories have two countervailing effects on manufacturers' incentives to sustain tacit collusion. First, granting local monopolies to retailers distributing a given brand softens inter- and intrabrand competition in a one-shot game. Hence, punishment profits are larger, thereby rendering deviation more profitable....

  10. Exclusion statistics and integrable models

    International Nuclear Information System (INIS)

    Mashkevich, S.

    1998-01-01

    The definition of exclusion statistics, as given by Haldane, allows for a statistical interaction between distinguishable particles (multi-species statistics). The thermodynamic quantities for such statistics ca be evaluated exactly. The explicit expressions for the cluster coefficients are presented. Furthermore, single-species exclusion statistics is realized in one-dimensional integrable models. The interesting questions of generalizing this correspondence onto the higher-dimensional and the multi-species cases remain essentially open

  11. Optic pathway glioma as part of a constitutional mismatch-repair deficiency syndrome in a patient meeting the criteria for neurofibromatosis type 1.

    Science.gov (United States)

    Yeung, Jacky T; Pollack, Ian F; Shah, Sapana; Jaffe, Ronald; Nikiforova, Marina; Jakacki, Regina I

    2013-01-01

    Patients with constitutional mismatch repair-deficiency (CMMR-D) caused by the biallelic deletions of mismatch repair (MMR) genes have a high likelihood of developing malignancies of the bone marrow, bowel, and brain. Affected individuals often have phenotypic features of neurofibromatosis type 1 (NF-1), including café-au-lait spots. Optic pathway gliomas (OPGs), a common manifestation of NF-1, have not been reported. We report the case of a 3-year-old male with an extensive OPG who met the diagnostic criteria for NF-1. He was subsequently found to have multiple colonic polyps and bi-allelic loss of PMS2. Testing for NF-1 was negative. Copyright © 2012 Wiley Periodicals, Inc.

  12. Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia (CAP) and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people? A compilation study of two prospective cohorts.

    Science.gov (United States)

    Myint, Phyo K; Kamath, Ajay V; Vowler, Sarah L; Maisey, David N; Harrison, Brian D W

    2006-05-01

    To assess the usefulness of the British Thoracic Society guidelines for severity assessment of community-acquired pneumonia (CAP) in predicting mortality and to explore alternative criteria which could be more useful in older patients. Compilation study of two prospective observational cohorts. A University hospital in Norfolk, UK with a catchment population of 568,000. Subjects were 195 patients (median age = 77 years) who were included in two prospective studies of CAP. All-cause mortality occurring within the 6 week follow-up. sensitivity, specificity, positive and negative predictive values for study outcome using CURB and CURB-65 were assessed in 189 patients, and CRB-65 in 192 patients out of a total of 195 patients. Our results were comparable with the original study by Lim et al. Although CURB-65 and CRB-65 included age criteria, in effect they did not materially improve the specificity in predicting high-risk patients in both studies. We found that oxygenation measured by ventilation perfusion mismatch (PaO2:FiO2) was the best predictor of outcome in this slightly older cohort [odds ratio (OR) = 0.99 (0.98-0.99), P = 0.0001]. We derived a new set of criteria; SOAR (systolic blood pressure, oxygenation, age and respiratory rate) based on our findings. Their sensitivity, specificity, positive and negative predictive values were 81.0% (58.1-94.6), 59.3% (49.6-68.4), 27.0% (16.6-39.7) and 94.4% (86.2-98.4), respectively, confirming their comparability with existing criteria. Our Study confirms the usefulness of currently recommended severity rules for CAP in this older cohort. SOAR criteria may be useful as alternative criteria for a better identification of severe CAP in advanced age where both raised urea level above 7 mmol/l and confusion are common.

  13. Concordance between (99m)Tc-ECD SPECT and 18F-FDG PET interpretations in patients with cognitive disorders diagnosed according to NIA-AA criteria.

    Science.gov (United States)

    Ito, Kimiteru; Shimano, Yasumasa; Imabayashi, Etsuko; Nakata, Yasuhiro; Omachi, Yoshie; Sato, Noriko; Arima, Kunimasa; Matsuda, Hiroshi

    2014-10-01

    The purpose of this study was to clarify the concordance of diagnostic abilities and interobserver agreement between 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and brain perfusion single photon-emission computed tomography (SPECT) in patients with Alzheimer's disease (AD) who were diagnosed according to the research criteria of the National Institute of Aging-Alzheimer's Association Workshop. Fifty-five patients with "AD and mild cognitive impairment (MCI)" (n = 40) and "non-AD" (n = 15) were evaluated with 18F-FDG PET and (99m)Tc-ethyl cysteinate dimer (ECD) SPECT during an 8-week period. Three radiologists independently graded the regional uptake in the frontal, temporal, parietal, and occipital lobes as well as the precuneus/posterior cingulate cortex in both images. Kappa values were used to determine the interobserver reliability regarding regional uptake. The regions with better interobserver reliability between 18F-FDG PET and (99m)Tc-ECD SPECT were the frontal, parietal, and temporal lobes. The (99m)Tc-ECD SPECT agreement in the occipital lobes was not significant. The frontal, temporal, and parietal lobes showed good correlations between 18F-FDG PET and (99m)Tc-ECD SPECT in the degree of uptake, but the occipital lobe and precuneus/posterior cingulate cortex did not show good correlations. The diagnostic accuracy rates of "AD and MCI" ranged from 60% to 70% in both of the techniques. The degree of uptake on 18F-FDG PET and (99m)Tc-ECD SPECT showed significant correlations in the frontal, temporal, and parietal lobes. The diagnostic abilities of 18F-FDG PET and (99m)Tc-ECD SPECT for "AD and MCI," when diagnosed according to the National Institute of Aging-Alzheimer's Association Workshop criteria, were nearly identical. Copyright © 2014 John Wiley & Sons, Ltd.

  14. Improved quality of management of eclampsia patients through criteria based audit at Muhimbili National Hospital, Dar es Salaam, Tanzania. Bridging the quality gap.

    Science.gov (United States)

    Kidanto, Hussein Lesio; Wangwe, Peter; Kilewo, Charles D; Nystrom, Lennarth; Lindmark, Gunnila

    2012-11-21

    Criteria-based audits (CBA) have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania. The prevalence of eclampsia in MNH is high (≈6%) with the majority of cases arriving after start of convulsions. In 2004-2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base). A criteria-based audit (CBA) was used to evaluate the quality of care for eclamptic mothers admitted at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania after implementation of recommendations of a previous audit. A CBA of eclampsia cases was conducted at MNH. Management practices were evaluated using evidence-based criteria for appropriate care. The Ministry of Health (MOH) guidelines, local management guidelines, the WHO manual supplemented by the WHO Reproductive Health Library, standard textbooks, the Cochrane database and reviews in peer reviewed journals were adopted. At the initial audit in 2006, 389 case notes were assessed and compared with the standards, gaps were identified, recommendations made followed by implementation. A re-audit of 88 cases was conducted in 2009 and compared with the initial audit. There was significant improvement in quality of patient management and outcome between the initial and re-audit: Review of management plan by senior staff (76% vs. 99%; P=0.001), urine for albumin test (61% vs. 99%; P=0.001), proper use of partogram to monitor labour (75% vs. 95%; P=0.003), treatment with steroids for lung maturity (2.0% vs. 24%; P=0.001), Caesarean section within 2 hours of decision (33% vs. 61%; P=0.005), full blood count (28% vs. 93%; P=0.001), serum urea and creatinine (44% vs. 86%; P=0.001), liver enzymes (4.0% vs. 86%; P=0.001), and specialist review within 2 hours of

  15. Improved quality of management of eclampsia patients through criteria based audit at Muhimbili National Hospital, Dar es Salaam, Tanzania. Bridging the quality gap

    Directory of Open Access Journals (Sweden)

    Kidanto Hussein

    2012-11-01

    Full Text Available Abstract Background Criteria-based audits (CBA have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania. Objective The prevalence of eclampsia in MNH is high (≈6% with the majority of cases arriving after start of convulsions. In 2004–2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base. A criteria-based audit (CBA was used to evaluate the quality of care for eclamptic mothers admitted at Muhimbili National Hospital (MNH, Dar es Salaam, Tanzania after implementation of recommendations of a previous audit. Methods A CBA of eclampsia cases was conducted at MNH. Management practices were evaluated using evidence-based criteria for appropriate care. The Ministry of Health (MOH guidelines, local management guidelines, the WHO manual supplemented by the WHO Reproductive Health Library, standard textbooks, the Cochrane database and reviews in peer reviewed journals were adopted. At the initial audit in 2006, 389 case notes were assessed and compared with the standards, gaps were identified, recommendations made followed by implementation. A re-audit of 88 cases was conducted in 2009 and compared with the initial audit. Results There was significant improvement in quality of patient management and outcome between the initial and re-audit: Review of management plan by senior staff (76% vs. 99%; P=0.001, urine for albumin test (61% vs. 99%; P=0.001, proper use of partogram to monitor labour (75% vs. 95%; P=0.003, treatment with steroids for lung maturity (2.0% vs. 24%; P=0.001, Caesarean section within 2 hours of decision (33% vs. 61%; P=0.005, full blood count (28% vs. 93%; P=0.001, serum urea and creatinine (44% vs. 86%; P=0.001, liver enzymes (4.0% vs

  16. Evaluation of proton MR spectroscopy at 3 Tesla without endorectal coil in patients with a localized prostate cancer treated with exclusive radiotherapy

    International Nuclear Information System (INIS)

    Crehange, G.

    2011-01-01

    Prostate cancer is the most frequent tumour affecting the male population. When the prostate is not removed and is treated with radiation therapy, PSA slowly decreases over time to reach its nadir, even sometimes 18 to 24 months after the completion of radiation therapy without combined androgen suppression therapy. When combined with hormones, PSA falls abruptly with no possibility to perceive the impact of either hormones or radiation effects on PSA.The optimal value of PSA that should be reached after radiation therapy (nadir) and time to this nadir are still unclear.Even when a satisfactory value of the PSA nadir is reached, on-going variations of the PSA and its 'bounce' effects, which occurs in 20% to 40% of the cases.Proton magnetic resonance spectroscopy allows one to assess the relative concentration of Choline and Citrate. Choline is a metabolite of whose concentration is often increased in the presence of a tumour, whereas the synthesis and the oxidation of Citrate are two decisive elements of the normal metabolism, functional abilities, growth, reproduction and survival of prostatic cells. This MR technique can be performed in combination with diffusion-weighted MRI and DCE-MRI (multi-parametric MRI).The goal of our study was to evaluate the feasibility of a 3D CSI proton MR spectroscopy of the entire prostate gland at 3.0 Tesla without an endorectal coil among patients with a localised prostate cancer treated with radiation therapy, with or without hormones. We first have classified spectra in a 5-point scale (from benign: class I, to malign: class V) based on a control group with radical prostatectomy as the standard of reference. This classification enabled us to establish a strong correlation between malignant spectra or the metabolic tumor volume and clinically validated prognostic factors.In parallel, a prospective clinical trial of which the aim is to Evaluate the Response to Irradiation with proton MR Spectroscopy (ERIS trial) has been set up to

  17. How to improve aesthetics in patients with Adolescent Idiopathic Scoliosis (AIS: a SPoRT brace treatment according to SOSORT management criteria

    Directory of Open Access Journals (Sweden)

    Fusco Claudia

    2009-09-01

    Full Text Available Abstract Background Aesthetics is a main goal of both conservative and surgical treatments in adolescent idiopathic scoliosis (AIS. Previously, we developed and validated a clinical scale - the Aesthetic Index (AI--in order to measure aesthetic impairment and changes during treatment. Aim To verify the efficacy of bracing on aesthetics in AIS. Study Design Prospective Cohort Study. Population Thirty-four consecutive patients, age 13.2 ± 3.7, initial Cobb Angle 32 ± 12°, ATR 10 ± 4° Bunnel, 11 males. Methods Patients with AI scores of at least 5/6 were included. Each of them had a brace prescription (18 to 23 hours per day, according to the SPoRT concept. AI was measured again after six months and at the end of treatment, and then the pre- and post-treatment scores compared. The Wilcoxon test was performed. Results Twenty-nine patients out of the 34 included completed the treatment and had six-month and final results; four patients were lost during the treatment, and one was fused. At baseline, median AI was 6 (95% IC 5-6 but the score decreased to 3 (95% IC 0-5; p Conclusion Aesthetics can be improved in a clinically significant way when the brace treatment is performed according to the SPoRT concept and by following the SOSORT management criteria. This is a relevant result for patients and a major goal of scoliosis treatment, be it conservative or surgical. The use of a more sensitive tool like TRACE could more easily detect the clinical changes; nevertheless, AI proved sensible enough that its use in everyday clinical practice can be suggested.

  18. Women in Chernobyl Exclusion Zone

    International Nuclear Information System (INIS)

    Balashevska, Y.; Kireev, S.; Navalikhin, V.

    2015-01-01

    Today, 29 years after the Chernobyl accident, the Exclusion Zone still remains an areal unsealed radiation source of around 2600 km"2. It is not just a gigantic radioactive waste storage facility (the amount of radioactive waste accumulated within the Zone, except for the Shelter, is estimated at about 2.8 million m"3), but also a unique research and engineering platform for biologists, radiologists, chemists and physicists. Taking into account the amount of the radionuclides released during the accident, it becomes quite understood that the radiological environment in the Exclusion Zone is far from favorable. However, among the Exclusion Zone personnel who numbers 5000, there are female workers. The poster represents the results of the research performed among the female employees of the largest enterprise of the Exclusion Zone, “Chornobyl Spetskombinat”. The survey was performed with the view to knowing what makes women work in the most radioactively contaminated area in Europe, and what their role is, to revealing their fears and hopes, and to estimating the chances of the brave women of Chernobyl Exclusion Zone to succeed in their careers. (author)

  19. RELIGIOUS EXCLUSIVITY AND PSYCHOSOCIAL FUNCTIONING.

    Science.gov (United States)

    Gegelashvili, M; Meca, A; Schwartz, S J

    2015-01-01

    In the present study we sought to clarify links between religious exclusivity, as form of intergroup favoritism, and indices of psychosocial functioning. The study of in group favoritism has generally been invoked within Social Identity Theory and related perspectives. However, there is a lack of literature regarding religious exclusivity from the standpoint of social identity. In particular, the ways in which religious exclusivity is linked with other dimensions of religious belief and practice, and with psychosocial functioning, among individuals from different religious backgrounds are not well understood. A sample of 8545 emerging-adult students from 30 U.S. universities completed special measures. Measure of religious exclusivity was developed and validated for this group. The results suggest that exclusivity appears as predictor for impaired psychosocial functioning, low self-esteem and low psychosocial well-being for individuals from organized faiths, as well as for those identifying as agnostic, atheist, or spiritual/nonreligious. These findings are discussed in terms of Social Identity Theory and Terror Management Theory (TMT).

  20. Non-sedation versus sedation with a daily wake-up trial in critically ill patients receiving mechanical ventilation-effects on physical function

    DEFF Research Database (Denmark)

    Nedergaard, Helene Korvenius; Jensen, Hanne Irene; Lauridsen, Jørgen T

    2015-01-01

    will be intubated, mechanically ventilated patients with expected duration of mechanical ventilation >24 h. Exclusion criteria will be patients with severe head trauma, coma at admission or status epilepticus, patients treated with therapeutic hypothermia, patients with PaO2/FiO2

  1. Prevalence of the American College of Rheumatology hematological classification criteria and associations with serological and clinical variables in 460 systemic lupus erythematosus patients

    Directory of Open Access Journals (Sweden)

    Thelma Skare

    2015-04-01

    Full Text Available Objective: To study systemic lupus erythematosus in a Brazilian population using the American College of Rheumatology hematological classification criteria and report associations of the disease with serological and clinical profiles. Methods: This is a retrospective study of 460 systemic lupus erythematosus patients followed in a single rheumatologic center during the last 10 years. Hematological manifestations considered for this study were hemolysis, leukopenia, lymphocytopenia and thrombocytopenia. Results: The cumulative prevalences of leukopenia, thrombocytopenia, lymphocytopenia and hemolytic anemia were 29.8%, 21.08%, 17.7% and 8.4%, respectively. A higher percentage of patients with hemolysis had anticardiolipin IgM (p-value = 0.002. Those with leukopenia had more lymphopenia (p-value = 0.02, psychosis (p-value = 0.01, thrombocy- topenia (p-value <0.0001 and anti-double stranded DNA antibodies (p-value = 0.03. Patients with lymphopenia had more leukopenia (OR = 1.8; 95% CI = 1.01-3.29 and lupus anticoagulant antibodies (OR = 2.2; 95% CI = 1.16-4.39 and those with thrombocytopenia had more leukopenia (OR = 3.1; 95% CI = 1.82-5.44 and antiphospholipid syndrome (OR = 3.1; 95% CI = 1.28-7.87. Conclusion: The most common hematological finding was leukopenia and the least common was hemolysis. Associations of low platelet count and hemolysis were found with antiphospholipid syndrome and anticardiolipin IgM positivity, respectively. Leukopenia and lymphocytopenia are correlated and leukopenia is more common in systemic lupus erythe- matosus patients with psychosis, thrombocytopenia and anti-double stranded DNA.

  2. Problems of Chernobyl exclusion zone

    International Nuclear Information System (INIS)

    1994-01-01

    The collection reflects the results of researches and test-design activities in the exclusion area of the Chernobyl NPP directed to elaborate the equipment and devices for scientific researches and elimination of the accident after effects at the Chernobyl NPP and to study composition and structure of solid-phase bearers of the activity in the soil of the exclusion area, form transformation of decay products, radionuclide composition of the fuel precipitation in the nearest zone of the Chernobyl NPP. Special attention is paid to medical-biological problems of the accident after effects influence on flora, fauna and human health, labour conditions and sick rate of people working in the exclusion area

  3. Proposed Diagnostic Criteria for Smartphone Addiction.

    Directory of Open Access Journals (Sweden)

    Yu-Hsuan Lin

    Full Text Available Global smartphone penetration has led to unprecedented addictive behaviors. The aims of this study are to develop diagnostic criteria of smartphone addiction and to examine the discriminative ability and the validity of the diagnostic criteria.We developed twelve candidate criteria for characteristic symptoms of smartphone addiction and four criteria for functional impairment caused by excessive smartphone use. The participants consisted of 281 college students. Each participant was systematically assessed for smartphone-using behaviors by psychiatrist's structured diagnostic interview. The sensitivity, specificity, and diagnostic accuracy of the candidate symptom criteria were analyzed with reference to the psychiatrists' clinical global impression. The optimal model selection with its cutoff point of the diagnostic criteria differentiating the smartphone addicted subjects from non-addicted subjects was then determined by the best diagnostic accuracy.Six symptom criteria model with optimal cutoff point were determined based on the maximal diagnostic accuracy. The proposed smartphone addiction diagnostic criteria consisted of (1 six symptom criteria, (2 four functional impairment criteria and (3 exclusion criteria. Setting three symptom criteria as the cutoff point resulted in the highest diagnostic accuracy (84.3%, while the sensitivity and specificity were 79.4% and 87.5%, respectively. We suggested determining the functional impairment by two or more of the four domains considering the high accessibility and penetration of smartphone use.The diagnostic criteria of smartphone addiction demonstrated the core symptoms "impaired control" paralleled with substance related and addictive disorders. The functional impairment involved multiple domains provide a strict standard for clinical assessment.

  4. Problems of Chernobyl exclusion zone

    International Nuclear Information System (INIS)

    1996-01-01

    The collection comprises the results of researches and design activity in the ChNPP exclusion zone with the aim to develop technology, equipment and instruments for RAW management and accident clean-up, studying of the composition and structure of the activity solid bearers in the soil of the exclusion zone and transformation of the radionuclides in the nearest zone of ChNPP. Much attention is paid to medical and biological problems of the accident influence on the flora, fauna and people's health labour conditions and incidence of the people involved

  5. Problems of Chornobyl Exclusion Zone

    International Nuclear Information System (INIS)

    Kashparov, V.A.

    2009-01-01

    The collection comprises the results of researches and design activity in the ChNPP exclusion zone with the aim to develop technology, equipment and instruments for RAW management and accident clean-up, studying of the composition and structure of the activity solid bearers in the soil of the exclusion zone and transformation of the radionuclides in the nearest zone of ChNPP. Much attention is paid to medical and biological problems of the accident influence on the flora, fauna and people's health, labour conditions and incidence of the people involved.

  6. Exclusion statistics and integrable models

    International Nuclear Information System (INIS)

    Mashkevich, S.

    1998-01-01

    The definition of exclusion statistics that was given by Haldane admits a 'statistical interaction' between distinguishable particles (multispecies statistics). For such statistics, thermodynamic quantities can be evaluated exactly; explicit expressions are presented here for cluster coefficients. Furthermore, single-species exclusion statistics is realized in one-dimensional integrable models of the Calogero-Sutherland type. The interesting questions of generalizing this correspondence to the higher-dimensional and the multispecies cases remain essentially open; however, our results provide some hints as to searches for the models in question

  7. Feasibility and acceptability of electronic symptom surveillance with clinician feedback using the Patient-Reported Outcomes version of Common Terminology Criteria for Adverse Events (PRO-CTCAE) in Danish prostate cancer patients

    DEFF Research Database (Denmark)

    Bæksted, Christina; Pappot, Helle; Nissen, Aase

    2017-01-01

    -CTCAE questionnaire on tablet computers using AmbuFlex software at each treatment visit in the outpatient clinic. In total, 22 symptomatic toxicities (41 PRO-CTCAE items), corresponding to the symptomatic adverse-events profile associated with the regimens commonly used for prostate cancer treatment (Docetaxel......Background: The aim was to examine the feasibility, acceptability and clinical utility of electronic symptom surveillance with clinician feedback using a subset of items drawn from the Patient-Reported Outcomes version of Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a cancer...

  8. Exclusive processes in quantum chromodynamics

    International Nuclear Information System (INIS)

    Brodsky, S.J.; Lepage, G.P.

    1981-06-01

    Large momentum transfer exclusive processes and the short distance structure of hadronic wave functions can be systematically analyzed within the context of perturbative QCD. Predictions for meson form factors, two-photon processes γγ → M anti M, hadronic decays of heavy quark systems, and a number of other related QCD phenomena are reviewed

  9. Exclusive meson production at COMPASS

    CERN Document Server

    Pochodzalla, Josef; Moinester, Murray; Piller, Gunther; Sandacz, Andrzej; Vanderhaeghen, Marc; Pochodzalla, Josef; Mankiewicz, Lech; Moinester, Murray; Piller, Gunther; Sandacz, Andrzej; Vanderhaeghen, Marc

    1999-01-01

    We explore the feasibility to study exclusive meson production (EMP) in hard muon-proton scattering at the COMPASS experiment. These measurements constrain the off-forward parton distributions (OFPD's) of the proton, which are related to the quark orbital contribution to the proton spin.

  10. Autoimmune hepatitis: diagnostic criteria, subclassifications, and clinical features.

    Science.gov (United States)

    McFarlane, Ian G

    2002-08-01

    The diagnosis of AIH depends on the finding of several suggestive features together with careful exclusion of liver diseases of other etiologies. Wherever possible, the diagnosis should be confirmed histologically by an experienced hepatopathologist. Seronegativity for the conventional autoantibodies at presentation does not exclude a diagnosis of AIH. It is important to test for anti-LKM1 antibodies to avoid missing a diagnosis of type 2 AIH, with potentially serious consequences. Although the syndrome is associated with characteristic biochemical abnormalities, and biochemical parameters are commonly used for monitoring response to therapy, it should be borne in mind that neither these nor autoantibody titers are completely reliable indices of disease activity. Although the various systems that have been promulgated for classification of the disease may identify different groups of patients on pathogenetic or clinical criteria and are useful for research purposes, none is yet sufficiently exclusive in terms of defining prognosis or planning treatment strategies to be applicable to the individual patient seen in the clinic. Clinical management should therefore continue to be individually tailored.

  11. Randomized trial of bioelectrical impedance analysis versus clinical criteria for guiding ultrafiltration in hemodialysis patients: effects on blood pressure, hydration status, and arterial stiffness.

    Science.gov (United States)

    Onofriescu, Mihai; Mardare, Nicoleta Genoveva; Segall, Liviu; Voroneanu, Luminiţa; Cuşai, Claudiu; Hogaş, Simona; Ardeleanu, Serban; Nistor, Ionuţ; Prisadă, Octavian Viorel; Sascău, Radu; Covic, Adrian

    2012-04-01

    < 0.001). In this group, PWV also decreased from 8.2 ± 2.3 to 6.9 ± 2.3 m/s (P = 0.001) and NT-proBNP decreased from 7,552 to 4,561 pg/ml (P = 0.001). BIA is not inferior and possibly even better than clinical criteria for assessing dry weight and guiding ultrafiltration in HD patients.

  12. Validity and Reliability of the U.S. National Cancer Institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)

    Science.gov (United States)

    Dueck, Amylou C.; Mendoza, Tito R.; Mitchell, Sandra A.; Reeve, Bryce B.; Castro, Kathleen M.; Rogak, Lauren J.; Atkinson, Thomas M.; Bennett, Antonia V.; Denicoff, Andrea M.; O'Mara, Ann M.; Li, Yuelin; Clauser, Steven B.; Bryant, Donna M.; Bearden, James D.; Gillis, Theresa A.; Harness, Jay K.; Siegel, Robert D.; Paul, Diane B.; Cleeland, Charles S.; Schrag, Deborah; Sloan, Jeff A.; Abernethy, Amy P.; Bruner, Deborah W.; Minasian, Lori M.; Basch, Ethan

    2016-01-01

    Importance Symptomatic adverse events (AEs) in cancer trials are currently reported by clinicians using the National Cancer Institute's (NCI) Common Terminology Criteria for Adverse Events (CTCAE). To integrate the patient perspective, the NCI developed a patient-reported outcomes version of the CTCAE (PRO-CTCAE) to capture symptomatic AEs directly from patients. Objective To assess the construct validity, test-retest reliability, and responsiveness of PRO-CTCAE items. Design Participants completed PRO-CTCAE items on tablet computers in clinic waiting rooms at two visits 1-6 weeks apart. A subset completed PRO-CTCAE items during an additional visit one business day after the first visit. Setting Nine U.S. cancer centers and community oncology practices. Participants 975 adult cancer patients undergoing outpatient chemotherapy and/or radiation enrolled between January 2011 and February 2012. Eligibility required participants to read English and be without clinically significant cognitive impairment. Main Outcome(s) and Measure(s) Primary comparators were clinician-reported Eastern Cooperative Oncology Group Performance Status (ECOG PS) and the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30). Results 940/975 (96%) and 852/940 (91%) participants completed PRO-CTCAE items at each visit. 938/940 (99.8%) participants (53% female, median age 59, 32% high school education or less, 17% ECOG PS 2-4) reported having at least one symptom. All PRO-CTCAE items had at least one correlation in the expected direction with a QLQ-C30 scale (111/124 P<.05). Stronger correlations were seen between PRO-CTCAE items and conceptually-related QLQ-C30 domains. Scores for 94/124 PRO-CTCAE items were higher in the ECOG PS 2-4 versus 0-1 group (58/124 P<.05). Overall, 119/124 items met at least one construct validity criterion. Test-retest reliability was acceptable for 36/49 pre-specified items (median intra-class correlation coefficient

  13. Danish Translation and Linguistic Validation of the U.S. National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)

    DEFF Research Database (Denmark)

    Bæksted, Christina; Nissen, Aase; Pappot, Helle

    2016-01-01

    CONTEXT: The Common Terminology Criteria for Adverse Events (CTCAE) is the basis for standardized clinician-based grading and reporting of adverse events in cancer clinical trials. The U.S. National Cancer Institute has developed the Patient-Reported Outcomes version of the CTCAE (PRO-CTCAE) to i......CONTEXT: The Common Terminology Criteria for Adverse Events (CTCAE) is the basis for standardized clinician-based grading and reporting of adverse events in cancer clinical trials. The U.S. National Cancer Institute has developed the Patient-Reported Outcomes version of the CTCAE (PRO...

  14. Disfunção sexual em pacientes com câncer do colo uterino avançado submetidas à radioterapia exclusiva Sexual dysfunction in patients with advanced cervical cancer submitted to exclusive radiotherapy

    Directory of Open Access Journals (Sweden)

    Bebiana Calisto Bernardo

    2007-02-01

    Full Text Available OBJETIVO: identificar disfunções sexuais em pacientes com câncer de colo uterino submetidas à radioterapia exclusiva pela técnica de braquiterapia de alta taxa de dose. MÉTODOS: foi realizado um estudo descritivo do tipo corte transversal no período de janeiro a junho de 2004. O estudo envolveu 71 pacientes selecionadas de acordo o perfil estabelecido e que vinham sendo seguidas no ambulatório de pélvis do Hospital do Câncer de Pernambuco. Os dados foram coletados a partir de um questionário estruturado, complementado por um exame ginecológico visando investigar queixas de disfunção sexual após a radioterapia. Foi utilizado o programa estatístico Epi-Info 6.04 para processamento e análise dos dados. A análise descritiva foi feita pela média, mediana, valores máximo e mínimo. Para análise bivariada foram realizados os testes de homogeneidade marginal e McNemar, considerando um nível de significância de 5%. RESULTADOS: das complicações ginecológicas identificadas, destacam-se fibrose, estenose e atrofia vaginais (98,6, 76,1 e 71,8% dos casos, respectivamente. As disfunções sexuais identificadas foram: frigidez e falta de lubrificação, de excitação e de orgasmo, que ocorreram em 76,1% dos casos, falta de libido em 40,8% e vaginismo em 5,6% dos casos. CONCLUSÕES: as disfunções sexuais são freqüentes em pacientes com câncer do colo uterino avançado tratadas com radioterapia exclusiva utilizando o protocolo de braquiterapia de alta taxa de dose. Atenção específica deve ser dada à anamnese sexual e ao exame ginecológico durante o acompanhamento destas pacientes.PURPOSE: to identify sexual dysfunctions in patients with cancer of the uterine cervix submitted to exclusive radiotherapy, using the high dose rate (HDR brachytherapy technique. METHODS: a descriptive transversal study from January to June of 2004. The study involved 71 selected patients who had been followed in the pelvis outpatient clinic from the

  15. Reliability of cortical lesion detection on double inversion recovery MRI applying the MAGNIMS-Criteria in multiple sclerosis patients within a 16-months period.

    Directory of Open Access Journals (Sweden)

    Tobias Djamsched Faizy

    Full Text Available In patients with multiple sclerosis (MS, Double Inversion Recovery (DIR magnetic resonance imaging (MRI can be used to identify cortical lesions (CL. We sought to evaluate the reliability of CL detection on DIR longitudinally at multiple subsequent time-points applying the MAGNIMs scoring criteria for CLs.26 MS patients received a 3T-MRI (Siemens, Skyra with DIR at 12 time-points (TP within a 16 months period. Scans were assessed in random order by two different raters. Both raters separately marked all CLs on each scan and total lesion numbers were obtained for each scan-TP and patient. After a retrospective re-evaluation, the number of consensus CLs (conL was defined as the total number of CLs, which both raters finally agreed on. CLs volumes, relative signal intensities and CLs localizations were determined. Both ratings (conL vs. non-consensus scoring were compared for further analysis.A total number of n = 334 CLs were identified by both raters in 26 MS patients with a first agreement of both raters on 160 out of 334 of the CLs found (κ = 0.48. After the retrospective re-evaluation, consensus agreement increased to 233 out of 334 CL (κ = 0.69. 93.8% of conL were visible in at least 2 consecutive TP. 74.7% of the conL were visible in all 12 consecutive TP. ConL had greater mean lesion volumes and higher mean signal intensities compared to lesions that were only detected by one of the raters (p<0.05. A higher number of CLs in the frontal, parietal, temporal and occipital lobe were identified by both raters than the number of those only identified by one of the raters (p<0.05.After a first assessment, slightly less than a half of the CL were considered as reliably detectable on longitudinal DIR images. A retrospective re-evaluation notably increased the consensus agreement. However, this finding is narrowed, considering the fact that retrospective evaluation steps might not be practicable in clinical routine. Lesions that were not reliably

  16. Agreement for depression diagnosis between DSM-IV-TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer

    Directory of Open Access Journals (Sweden)

    Rhondali W

    2015-07-01

    Anxiety Depression Scale, the distress thermometer, the mood thermometer, and OA. The interview guide for PCI was constructed from three validated scales: the GDS, the Hamilton Depression Rating Scale, and the Montgomery Asberg Depression Rating Scale (MADRS. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised (DSM criteria for depression were used as a gold standard.Results: Out of 109 patients enrolled at 21 centers, 99 (91% completed all the assessments. Patient characteristics were: mean age 78, performance status ≥2: 47 (47%. Thirty six patients (36% were identified as depressed by the PCI versus 15 (15% identified by DSM. We found moderate agreement for depression identification between DSM and GDS (κ=0.508 and PCI (κ=0.431 and high agreement with MADRS (κ=0.663. We found low or no agreement between DSM with the other assessment strategies, including OA (κ=-0.043. Identification according to OA (yes/no resulted in a false-negative rate of 87%. As a screening tool, GDS had the best sensitivity and specificity (94% and 80%, respectively.Conclusion: The use of validated tools, such as GDS, and collaboration between psychologists and oncologists are warranted to better identify emotional disorders in elderly women with AOC. Keywords: depression, elderly, cancer, screening, geriatric assessment

  17. ACR appropriateness criteria jaundice.

    Science.gov (United States)

    Lalani, Tasneem; Couto, Corey A; Rosen, Max P; Baker, Mark E; Blake, Michael A; Cash, Brooks D; Fidler, Jeff L; Greene, Frederick L; Hindman, Nicole M; Katz, Douglas S; Kaur, Harmeet; Miller, Frank H; Qayyum, Aliya; Small, William C; Sudakoff, Gary S; Yaghmai, Vahid; Yarmish, Gail M; Yee, Judy

    2013-06-01

    A fundamental consideration in the workup of a jaundiced patient is the pretest probability of mechanical obstruction. Ultrasound is the first-line modality to exclude biliary tract obstruction. When mechanical obstruction is present, additional imaging with CT or MRI can clarify etiology, define level of obstruction, stage disease, and guide intervention. When mechanical obstruction is absent, additional imaging can evaluate liver parenchyma for fat and iron deposition and help direct biopsy in cases where underlying parenchymal disease or mass is found. Imaging techniques are reviewed for the following clinical scenarios: (1) the patient with painful jaundice, (2) the patient with painless jaundice, and (3) the patient with a nonmechanical cause for jaundice. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  18. Criteria for definition of regional functional improvement on quantitative post-stress gated myocardial SPET after bypass surgery in patients with ischaemic cardiomyopathy

    International Nuclear Information System (INIS)

    Lee, Dong Soo; Cheon, Gi Jeong; Paeng, Jin Chul; Chung, June-Key; Lee, Myung Chul; Kim, Ki Bong

    2002-01-01

    Myocardial viability can be defined as functional improvement of dysfunctional myocardium after revascularization. The purpose of this study was to define the optimal criteria for definition of regional functional improvement after coronary artery bypass graft (CABG) surgery on quantitative gated single-photon emission tomography (SPET). Thirty-two patients (26 men, 6 women; age 56±13 years) with coronary artery disease (three-vessel disease, 17; two-vessel disease, 15; previous history of myocardial infarction, 9) and severe left ventricular dysfunction (LVEF≤35%) underwent CABG. Rest thallium-201/dipyridamole stress technetium-99m methoxyisobutylisonitrile gated myocardial SPET was performed before and 3 months after CABG. Global LV functional improvement was defined as either an improvement in LVEF of 10% (n=15) or an improvement in LVEF of 5% combined with a decrease in end-systolic volume of 10 ml (n=2) after CABG on quantitative gated SPET. Postoperative regional wall thickening improvement (ΔRWT), regional wall motion improvement (ΔRWM) and regional resting (ΔRP) and stress perfusion improvement (ΔRstrP) were used to determine global functional improvement by ROC curve analysis, and the optimal criteria for definition of viable regional dysfunctional myocardium were defined on the ROC curves. Correlations were verified by determining the number of improved myocardial regions and LVEF improvement. LVEF was improved from 25%±6% to 34%±11% after CABG. A total of 229 segments were dysfunctional (wall motion ≤2 mm, thickening ≤20%) before CABG. On ROC curve analysis using global functional improvement as an indicator of viability, the areas under the ROC curves (AUCs) of ΔRWT and ΔRWM were 0.717 and 0.620, respectively. The AUC of ΔRWT was significantly larger than that of ΔRWM (P=0.009) and the optimal cut-off value of ΔRWT was 15%. The AUCs of ΔRP and ΔRstrP were not significant. The correlation coefficients between summed ΔRWT and

  19. Tensor GSVD of patient- and platform-matched tumor and normal DNA copy-number profiles uncovers chromosome arm-wide patterns of tumor-exclusive platform-consistent alterations encoding for cell transformation and predicting ovarian cancer survival.

    Directory of Open Access Journals (Sweden)

    Preethi Sankaranarayanan

    Full Text Available The number of large-scale high-dimensional datasets recording different aspects of a single disease is growing, accompanied by a need for frameworks that can create one coherent model from multiple tensors of matched columns, e.g., patients and platforms, but independent rows, e.g., probes. We define and prove the mathematical properties of a novel tensor generalized singular value decomposition (GSVD, which can simultaneously find the similarities and dissimilarities, i.e., patterns of varying relative significance, between any two such tensors. We demonstrate the tensor GSVD in comparative modeling of patient- and platform-matched but probe-independent ovarian serous cystadenocarcinoma (OV tumor, mostly high-grade, and normal DNA copy-number profiles, across each chromosome arm, and combination of two arms, separately. The modeling uncovers previously unrecognized patterns of tumor-exclusive platform-consistent co-occurring copy-number alterations (CNAs. We find, first, and validate that each of the patterns across only 7p and Xq, and the combination of 6p+12p, is correlated with a patient's prognosis, is independent of the tumor's stage, the best predictor of OV survival to date, and together with stage makes a better predictor than stage alone. Second, these patterns include most known OV-associated CNAs that map to these chromosome arms, as well as several previously unreported, yet frequent focal CNAs. Third, differential mRNA, microRNA, and protein expression consistently map to the DNA CNAs. A coherent picture emerges for each pattern, suggesting roles for the CNAs in OV pathogenesis and personalized therapy. In 6p+12p, deletion of the p21-encoding CDKN1A and p38-encoding MAPK14 and amplification of RAD51AP1 and KRAS encode for human cell transformation, and are correlated with a cell's immortality, and a patient's shorter survival time. In 7p, RPA3 deletion and POLD2 amplification are correlated with DNA stability, and a longer survival

  20. Do MCI criteria in drug trials accurately identify subjects with predementia Alzheimer's disease?

    Science.gov (United States)

    Visser, P; Scheltens, P; Verhey, F

    2005-01-01

    Background: Drugs effective in Alzheimer-type dementia have been tested in subjects with mild cognitive impairment (MCI) because these are supposed to have Alzheimer's disease in the predementia stage. Objectives: To investigate whether MCI criteria used in these drug trials can accurately diagnose subjects with predementia Alzheimer's disease. Methods: MCI criteria of the Gal-Int 11 study, InDDEx study, ADCS memory impairment study, ampakine CX 516 study, piracetam study, and Merck rofecoxib study were applied retrospectively in a cohort of 150 non-demented subjects from a memory clinic. Forty two had progressed to Alzheimer type dementia during a five year follow up period and were considered to have predementia Alzheimer's disease at baseline. Outcome measures were the odds ratio, sensitivity, specificity, and positive and negative predictive value. Results: The odds ratio of the MCI criteria for predementia Alzheimer's disease varied between 0.84 and 11. Sensitivity varied between 0.46 and 0.83 and positive predictive value between 0.43 and 0.76. None of the criteria combined a high sensitivity with a high positive predictive value. Exclusion criteria for depression led to an increase in positive predictive value and specificity at the cost of sensitivity. In subjects older than 65 years the positive predictive value was higher than in younger subjects. Conclusions: The diagnostic accuracy of MCI criteria used in trials for predementia Alzheimer's disease is low to moderate. Their use may lead to inclusion of many patients who do not have predementia Alzheimer's disease or to exclusion of many who do. Subjects with moderately severe depression should not be excluded from trials in order not to reduce the sensitivity. PMID:16170074

  1. Problems of Chernobyl exclusion zone

    International Nuclear Information System (INIS)

    1996-01-01

    The collection comprises the results of researches and design activity in the ChNPP exclusion zone with the aim to develop technology, equipment and instruments for RAW management and accident clean-up, studying of the composition and structure of the activity solid bearers in the soil of the exclusion zone and transformation of the radionuclides in the nearest zone of ChNPP. Much attention is paid to medical and biological problems of the accident influence on the flora, fauna and people's health, labour conditions and incidence of the people involved. The collection comprises the information for scientists, experts, postgraduates and students in gaged in ecology, radioecology, nuclear engineering, radiology, radiochemistry and radiobiology

  2. Exclusive photoreactions on light nuclei

    International Nuclear Information System (INIS)

    Maruyama, K.

    1989-08-01

    The mechanism of photon absorption on light nuclei in the Δ-resonance region is discussed. The present status of experimental results is briefly summarized. A recent data from 1.3-GeV Tokyo ES using a π sr spectrometer is introduced. Exclusive measurements of the photodisintegration of 3 He and 4 He may be a clear way to identify 2N, 3N and 4N absorptions. (author)

  3. Gender, Marginalisation and Social Exclusion

    DEFF Research Database (Denmark)

    D. Munk, Martin

    The paper is focused on the fact that marginalisation and social exclusion are gender-related in the EU. Even when boys and girls experience the same kinds of strain and social inheritance, they react socially different. Likewise women and men are marginalised in different ways. The differing...... access to the five ressources: cultural, financial, mental, social and powerrelated resources is highlighted. It is demonstrated how gender involves living in different realities, and requires different solutions to create equal possibilities....

  4. Generic selection criteria for safety and patient benefit [V]: Comparing the pharmaceutical properties and patient usability of original and generic nasal spray containing ketotifen fumarate.

    Science.gov (United States)

    Wada, Yuko; Ami, Shyoko; Nozawa, Mitsuru; Goto, Miho; Shimokawa, Ken-Ichi; Ishii, Fumiyoshi

    The pH, osmotic pressure (cryoscopy), viscosity, squeeze force, spray angle, and spraying frequency of nasal spray containing ketotifen fumarate (1 brand-name product and 8 generic products) were measured. Based on the results of pH measurement, all products were weakly acidic (4.0 to 5.1). For all products, the osmotic pressure ratio to physiological saline was approximately 1. The viscosity of various products ranged from approximately 1.0 to 1.5 mPa·s. The spray angle of drug solution differed among the products: minimum, 46 degrees (Sawai and Fusachol); and maximum, 68.7 degrees (Sekiton). In particular, TOA, Sawai, Fusachol, and TYK showed significantly smaller angles compared to Zaditen (brand-name product). Container properties varied among the products: minimum squeeze force, 19.0 N (Sekiton); and maximum squeeze force, 43.1 N (Sawai). Based on these results, although all the above products are identical in dosage form and active ingredient, the differences in pharmaceutical properties, such as container operations and drug-solution spraying/attachment, may markedly influence patients' subjective opinions.

  5. Internet Presentation of Departments of Pediatric Surgery in Germany and Their Compliance with Recommended Criteria for Promoting Services and Offering Professional Information for Patients.

    Science.gov (United States)

    Farhat, Naim; Zoeller, Christoph; Petersen, Claus; Ure, Benno

    2016-08-01

    Introduction The presentation of health institutions in the internet is highly variable concerning marketing features and medical information. We aimed to investigate the structure and the kind of information provided on the Web sites of all departments of pediatric surgery in Germany. Furthermore, we aimed to identify the degree to which these Web sites comply with internet marketing recommendations for generating business. Method The Web sites of all pediatric surgery units referred to as departments on the official Web site of the German Society of Pediatric Surgery (GSPS) were assessed. The search engine Google was used by entering the terms "pediatric surgery" and the name of the city. Besides general data eight content characteristics focusing on ranking, accessibility, use of social media, multilingual sites, navigation options, selected images, contact details, and medical information were evaluated according to published recommendations. Results A total of 85 departments of pediatric surgery were included. On Google search results 44 (52%) ranked number one and 34 (40%) of the department's homepages were accessible directly through the homepage link of the GSPS. A link to own digital and/or social media was offered on 11 (13%) homepages. Nine sites were multilingual. The most common navigation bar item was clinical services on 74 (87%) homepages. Overall, 76 (89%) departments presented their doctors and 17 (20%) presented other staff members with images of doctors on 53 (62%) and contact data access from the homepage on 68 (80%) Web sites. On 25 (29%) Web sites information on the medical conditions treated were presented, on 17 (20%) details of treating concepts, and on 4 (5%) numbers of patients with specific conditions treated in the own department per year. Conclusion We conclude that numerous of the investigated online presentations do not comply with recommended criteria for offering professional information for patients and for promoting

  6. Detailed clinicopathological characterization of progressive alopecia areata patients treated with i.v. corticosteroid pulse therapy toward optimization of inclusion criteria.

    Science.gov (United States)

    Sato, Misato; Amagai, Masayuki; Ohyama, Manabu

    2014-11-01

    The management of progressive alopecia areata (AA) is often challenging. Recently, i.v. corticosteroid pulse therapy has been reported to be effective for acute and severe AA, however, inclusion criteria have not been sufficiently precise, leaving a chance that its efficacy could be further improved by optimizing therapeutic indications. In our attempts to delineate the factors that correlate with favorable outcomes, we minutely evaluated the clinicopathological findings and the prognoses of single-round steroid pulse-treated progressive AA cases with full sets of image and pathology records during the course. Almost complete hair regrowth has been achieved and maintained up to 2 years in five out of seven AA patients with varying degrees of clinical severity. Interestingly, the worst clinical presentation observed during the course correlated with the size of the area where hairs with dystrophic roots were pulled rather than the extent of visible hair loss on the first visit. Dermoscopy detected disease spread but contributed little in assessing prognoses. Dense perifollicular cell infiltration was detected in all cases treated within 4 weeks of onset and those treated later but with excellent response. Importantly, the cases with poor or incomplete hair regrowth were treated 6-8 weeks of onset and showed moderate inflammatory change with high telogen conversion rate. These findings mandate global dermoscopy and hair pull test for judging the treatment indication and suggest that early administration of high-dose corticosteroid, ideally within 4 weeks of onset, enable efficient suppression of active inflammation and maximize the effectiveness of the remedy. © 2014 Japanese Dermatological Association.

  7. [Allergic colitis in exclusively breast-fed infants].

    Science.gov (United States)

    Sierra Salinas, C; Blasco Alonso, J; Olivares Sánchez, L; Barco Gálvez, A; del Río Mapelli, L

    2006-02-01

    Eosinophilic colitis is induced by antigens present in cow's milk proteins in formula or human milk. In the last few years, an increasing number of cases have been diagnosed in exclusively breast-fed infants. We performed a retrospective study of 13 infants diagnosed with allergic colitis in our unit between January 1997 and January 2004. All the infants had been exclusively breast-fed. In all patients, initial symptoms were digestive (12 with mucus and bloody stools). Onset of symptoms occurred at 0-3 months in 77 %. Laboratory data of the allergic compound were negative. The main locations were the descending and sigmoid colon (75 %). Biopsy demonstrated acute inflammation, with neutrophil infiltration and an increase in eosinophils. In all patients, initial treatment consisted of exclusion of cow's milk proteins from the mother's diet. Ten of the 13 patients showed no improvement, requiring exclusive administration of protein-free hydrolyzate. In 3 infants, breastfeeding was maintained (breastfeeding without cow's milk proteins plus hydrolyzate). Diagnosis of eosinophilic colitis is based on exclusion of other causes of specific colitis and typical endoscopic and ultrastructural findings. Moreover, a satisfactory response to dietary treatment must be demonstrated. This diagnosis should be considered in breast-fed infants with rectal bleeding without involvement of general health status.

  8. Evaluating Dependence Criteria for Caffeine

    OpenAIRE

    Striley, Catherine L.W.; Griffiths, Roland R.; Cottler, Linda B.

    2011-01-01

    Background: Although caffeine is the most widely used mood-altering drug in the world, few studies have operationalized and characterized Diagnostic and Statistical Manual IV (DSM-IV) substance dependence criteria applied to caffeine. Methods: As a part of a nosological study of substance use disorders funded by the National Institute on Drug Abuse, we assessed caffeine use and dependence symptoms among high school and college students, drug treatment patients, and pain clinic patients who re...

  9. Applying the Quebec Task Force criteria as a frame of reference for studies of whiplash injuries

    NARCIS (Netherlands)

    Versteegen, GJ; van Es, FD; Kingma, J; Meijler, WJ; ten Duis, HJ

    Research prior to 1995 showed a diversity of either inclusion or exclusion criteria (or both) for diagnosing whiplash injury. As a consequence, the Quebec Task Force (QTF) developed expert-based criteria, which may be considered as a the 'new' gold standard. Here, we examined the inclusion criteria

  10. Classification, diagnostic criteria, and treatment recommendations for orofacial manifestations in HIV-infected pediatric patients. Collaborative Workgroup on Oral Manifestations of Pediatric HIV Infection.

    Science.gov (United States)

    Ramos-Gomez, F J; Flaitz, C; Catapano, P; Murray, P; Milnes, A R; Dorenbaum, A

    1999-01-01

    The criteria for diagnosis of HIV-related oral lesions in adults are well established, but corresponding criteria in the pediatric population are not as well defined. The Collaborative Workgroup on the Oral Manifestations of Pediatric HIV infection reached a consensus, based upon available data, as to the presumptive and definitive criteria to diagnose the oral manifestations of HIV infection in children. Presumptive criteria refer to the clinical features of the lesions, including signs and symptoms, whereas definitive criteria require specific laboratory tests. In general, it is recommended that definitive criteria be established whenever possible. Orofacial manifestations have been divided into three groups: 1) those commonly associated with pediatric HIV infection; 2) those less commonly associated with pediatric HIV infection; and 3) those strongly associated with HIV infection but rare in children. Orofacial lesions commonly associated with pediatric HIV infection include candidiasis, herpes simplex infection, linear gingival erythema, parotid enlargement, and recurrent aphthous stomatitis. In contrast, orofacial lesions strongly associated with HIV infection but rare in children include Kaposi's sarcoma, non-Hodgkin's lymphoma, and oral hairy leukoplakia. Treatment recommendations, specific for this age group, have been included for some of the more common HIV-related orofacial manifestations.

  11. Social exclusion domains of the elderly: A systematic review

    Directory of Open Access Journals (Sweden)

    Maliheh Khalvati

    2015-03-01

    Full Text Available Background: The elderly are considered as one of the vulnerable groups as they are subjected to the risk of decrease of participation in different domains of their life due to losing their jobs, a drop in salary and the increase of health-related problems. The current research was aimed to seek the elderly social exclusion domains in various countries around the world. Methods: This systematic review analyzed the published studies from 1999 to 2013. The articles were searched using the keywords of social exclusion along with old people, aging, elderly both in Persian and English in Google search engine and the Iranian and international databases. From among 77 studies obtained, 16 studies met the inclusion criteria for this research. Results: the findings indicated that the majority of studies (9 were conducted in Britain and the most common logical model was distributional and relational approach. Indicators were categorized in 5 domains: economic, social, health, environmental and neighborhood, and discrimination and elderly-oriented. In 50 percent of studies, access or lack of access to services, civil participations and social relations, in 12.5 percent of studies, access to proper health and in 18.7 percent of studies, living in secure environment and neighborhood were the indicators which attracted the most attention in evaluating the elderly social exclusion. Conclusion: Generally, choosing a logical and proper model to design and evaluate social exclusion contributed to decreasing the problems of social exclusion evaluation. Using the data gathered in family panels can also facilitate access to the data related to periodical evaluation of social exclusion.

  12. The role of exclusive breastfeeding in prevention of childhood epilepsy

    Directory of Open Access Journals (Sweden)

    Alexander Kurniadi

    2015-10-01

    Full Text Available Background Epilepsy affects 1% of children worldwide. The highest incidence is in the first year of life, and perinatal factors, such as hypoxic-ischemic injury, infection, and cortical malformation may play etiologic roles. Breast milk contains optimal nutrients for human brain in early life. Breastfeeding has been associated with lower risk of infections, better cognitive and psychomotor development. However, the role of breastfeeding in preventing childhood epilepsy remains unclear. Objective To evaluate an association between exclusive breastfeeding and childhood epilepsy. Methods A case-control study conducted from 1 May to 3 July 2013 involving children with epilepsy aged 6 months to 18 years who were attending pediatric outpatient clinic of Dr. Sardjito Hospital, Yogyakarta. Neurologically normal children, individually matched by age and sex, visiting the same clinic were considered as controls. Exclusion criteria were children with structural brain abnormality, history of epilepsy in family, and who had history of neonatal seizure, intracranial infection, febrile seizure, and head trauma before onset of epilepsy. History of breastfeeding was obtained by interviewing the parents. The difference of exclusively breastfeeding proportion between cases and controls was analyzed by McNemar test. Results The total number of participants was 68 cases and controls each. Subjects with epilepsy had lower proportion of exclusively breastfed (48.5% compared with controls (54.4%, but the difference was not statistically significant (P=0.541. Exclusively breastfeeding showed no statistical significance in decreasing risk of epilepsy (OR=0.71; 95%CI 0.32 to 1.61. Conclusions Exclusive breastfeeding for 4-6 months has no effect against childhood epilepsy.

  13. Social Exclusion of Disadvantaged Groups in the Modern Russian Society

    Directory of Open Access Journals (Sweden)

    Evelina Ravilevna Galieva

    2017-09-01

    Full Text Available Social exclusion is both a scientific theory and a socio-political discourse. This paper deals with the study of social exclusion of deprived groups such as drug users, which is based on an analysis of complex issues arising from the spread and use of psychoactive substances. The spread of drug abuse as a phenomenon is the cause of the stigmatization of communities and the exclusion of drug users from societies. The problem carriers are not only patients with drug addiction, but also those who have experience of one-time, episodic experiments with drugs and psychotropic substances. This paper is based on the results of empirical studies, which the subject was the study of drug use practices in modern society. The combination of a quantitative and qualitative strategy for data collection and analysis represented a dynamic accumulation of information at different levels about the object under study – social exclusion of drug users: methods of document analysis were applied such as regulatory legal acts, interviews with drug users and experts in the field of drug use and questionnaire survey, as well as secondary analysis of data from all-Russian sociological research. The social exclusion of deprived groups and ways to overcome it directly depend on the nature of the scenarios for social exclusion, which is the result of the stigmatization of deprived groups.

  14. Factors influencing knowledge and practice of exclusive ...

    African Journals Online (AJOL)

    Factors influencing knowledge and practice of exclusive breastfeeding in Nyando ... The overall objective of this study was to determine factors influencing the ... EBF and its benefits), pre lacteal feeds and exclusive breastfeeding consistency.

  15. Exclusive electroproduction of pion pairs

    International Nuclear Information System (INIS)

    Warkentin, N.; Schaefer, A.; Diehl, M.; Ivanov, D. Yu.

    2007-01-01

    We investigate electroproduction of pion pairs on the nucleon in the framework of QCD factorization for hard exclusive processes. We extend previous analyses by taking the hard-scattering coefficients at next-to-leading order in α s . The dynamics of the produced pion pair is described by two-pion distribution amplitudes, for which we perform a detailed theoretical and phenomenological analysis. In particular, we obtain constraints on these quantities by comparing our results with measurements of angular observables that are sensitive to the interference between two-pion production in the isoscalar and isovector channels. (orig.)

  16. Exclusion Bounds for Extended Anyons

    Science.gov (United States)

    Larson, Simon; Lundholm, Douglas

    2018-01-01

    We introduce a rigorous approach to the many-body spectral theory of extended anyons, that is quantum particles confined to two dimensions that interact via attached magnetic fluxes of finite extent. Our main results are many-body magnetic Hardy inequalities and local exclusion principles for these particles, leading to estimates for the ground-state energy of the anyon gas over the full range of the parameters. This brings out further non-trivial aspects in the dependence on the anyonic statistics parameter, and also gives improvements in the ideal (non-extended) case.

  17. Tensor GSVD of Patient- and Platform-Matched Tumor and Normal DNA Copy-Number Profiles Uncovers Chromosome Arm-Wide Patterns of Tumor-Exclusive Platform-Consistent Alterations Encoding for Cell Transformation and Predicting Ovarian Cancer Survival

    Science.gov (United States)

    Sankaranarayanan, Preethi; Schomay, Theodore E.; Aiello, Katherine A.; Alter, Orly

    2015-01-01

    The number of large-scale high-dimensional datasets recording different aspects of a single disease is growing, accompanied by a need for frameworks that can create one coherent model from multiple tensors of matched columns, e.g., patients and platforms, but independent rows, e.g., probes. We define and prove the mathematical properties of a novel tensor generalized singular value decomposition (GSVD), which can simultaneously find the similarities and dissimilarities, i.e., patterns of varying relative significance, between any two such tensors. We demonstrate the tensor GSVD in comparative modeling of patient- and platform-matched but probe-independent ovarian serous cystadenocarcinoma (OV) tumor, mostly high-grade, and normal DNA copy-number profiles, across each chromosome arm, and combination of two arms, separately. The modeling uncovers previously unrecognized patterns of tumor-exclusive platform-consistent co-occurring copy-number alterations (CNAs). We find, first, and validate that each of the patterns across only 7p and Xq, and the combination of 6p+12p, is correlated with a patient’s prognosis, is independent of the tumor’s stage, the best predictor of OV survival to date, and together with stage makes a better predictor than stage alone. Second, these patterns include most known OV-associated CNAs that map to these chromosome arms, as well as several previously unreported, yet frequent focal CNAs. Third, differential mRNA, microRNA, and protein expression consistently map to the DNA CNAs. A coherent picture emerges for each pattern, suggesting roles for the CNAs in OV pathogenesis and personalized therapy. In 6p+12p, deletion of the p21-encoding CDKN1A and p38-encoding MAPK14 and amplification of RAD51AP1 and KRAS encode for human cell transformation, and are correlated with a cell’s immortality, and a patient’s shorter survival time. In 7p, RPA3 deletion and POLD2 amplification are correlated with DNA stability, and a longer survival. In Xq

  18. Donor selection criteria and procurement

    International Nuclear Information System (INIS)

    Agcaoili, N.R.

    1999-01-01

    Donor selection is one of the most important aspects of tissue banking practice. Without a good donor selection criteria, the results of any effort of trying to preserve tissues will have disastrous outcome for the recipient of these tissues. While with a very good and strict donor selection the Tissue Bank can guarantee safe and effective tissue allografts. There are significant aspects in the history and physical examination of the donor that must be emphasized. A donor exclusion criteria has also been formulated together with a list of all the needed laboratory examinations to eliminate possible diseases that may be transferred from the donor. The methods of procurement of tissue allografts from living and cadaver donors will be described. The limitations and advantages of each will be taken.There are also special restrictions that are important in the practice of removing the tissues from the donors. All the necessary equipment should be ready and the potential risk on the personnel should be known to all doing Tissue Banking

  19. Feasibility of Patient Reporting of Symptomatic Adverse Events via the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a Chemoradiotherapy Cooperative Group Multicenter Clinical Trial

    International Nuclear Information System (INIS)

    Basch, Ethan; Pugh, Stephanie L.; Dueck, Amylou C.; Mitchell, Sandra A.; Berk, Lawrence; Fogh, Shannon; Rogak, Lauren J.; Gatewood, Marcha; Reeve, Bryce B.; Mendoza, Tito R.; O'Mara, Ann M.; Denicoff, Andrea M.; Minasian, Lori M.; Bennett, Antonia V.; Setser, Ann; Schrag, Deborah

    2017-01-01

    Purpose: To assess the feasibility of measuring symptomatic adverse events (AEs) in a multicenter clinical trial using the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Methods and Materials: Patients enrolled in NRG Oncology's RTOG 1012 (Prophylactic Manuka Honey for Reduction of Chemoradiation Induced Esophagitis-Related Pain during Treatment of Lung Cancer) were asked to self-report 53 PRO-CTCAE items representing 30 symptomatic AEs at 6 time points (baseline; weekly ×4 during treatment; 12 weeks after treatment). Reporting was conducted via wireless tablet computers in clinic waiting areas. Compliance was defined as the proportion of visits when an expected PRO-CTCAE assessment was completed. Results: Among 226 study sites participating in RTOG 1012, 100% completed 35-minute PRO-CTCAE training for clinical research associates (CRAs); 80 sites enrolled patients, of which 34 (43%) required tablet computers to be provided. All 152 patients in RTOG 1012 agreed to self-report using the PRO-CTCAE (median age 66 years; 47% female; 84% white). Median time for CRAs to learn the system was 60 minutes (range, 30-240 minutes), and median time for CRAs to teach a patient to self-report was 10 minutes (range, 2-60 minutes). Compliance was high, particularly during active treatment, when patients self-reported at 86% of expected time points, although compliance was lower after treatment (72%). Common reasons for noncompliance were institutional errors, such as forgetting to provide computers to participants; patients missing clinic visits; Internet connectivity; and patients feeling “too sick.” Conclusions: Most patients enrolled in a multicenter chemoradiotherapy trial were willing and able to self-report symptomatic AEs at visits using tablet computers. Minimal effort was required by local site staff to support this system. The observed causes of missing data may be obviated by

  20. Feasibility of Patient Reporting of Symptomatic Adverse Events via the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a Chemoradiotherapy Cooperative Group Multicenter Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Basch, Ethan, E-mail: ebasch@med.unc.edu [Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina (United States); Pugh, Stephanie L. [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Dueck, Amylou C. [Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, Arizona (United States); Mitchell, Sandra A. [Division of Cancer Control and Population Sciences, Outcomes Research Branch, National Cancer Institute, Rockville, Maryland (United States); Berk, Lawrence [Radiation Oncology, University of South Florida, Tampa, Florida (United States); Fogh, Shannon [Department of Radiation Oncology, University of California, San Francisco, San Francisco, California (United States); Rogak, Lauren J. [Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Gatewood, Marcha [Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (United States); Reeve, Bryce B. [Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina (United States); Mendoza, Tito R. [Department of Symptom Research, The University of Texas MD. Anderson Cancer Center, Houston, Texas (United States); O' Mara, Ann M.; Denicoff, Andrea M.; Minasian, Lori M. [Division of Cancer Control and Population Sciences, Outcomes Research Branch, National Cancer Institute, Rockville, Maryland (United States); Bennett, Antonia V. [Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina (United States); Setser, Ann [Setser Health Consulting, LLC, St. Louis, Missouri (United States); Schrag, Deborah [Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); and others

    2017-06-01

    Purpose: To assess the feasibility of measuring symptomatic adverse events (AEs) in a multicenter clinical trial using the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Methods and Materials: Patients enrolled in NRG Oncology's RTOG 1012 (Prophylactic Manuka Honey for Reduction of Chemoradiation Induced Esophagitis-Related Pain during Treatment of Lung Cancer) were asked to self-report 53 PRO-CTCAE items representing 30 symptomatic AEs at 6 time points (baseline; weekly ×4 during treatment; 12 weeks after treatment). Reporting was conducted via wireless tablet computers in clinic waiting areas. Compliance was defined as the proportion of visits when an expected PRO-CTCAE assessment was completed. Results: Among 226 study sites participating in RTOG 1012, 100% completed 35-minute PRO-CTCAE training for clinical research associates (CRAs); 80 sites enrolled patients, of which 34 (43%) required tablet computers to be provided. All 152 patients in RTOG 1012 agreed to self-report using the PRO-CTCAE (median age 66 years; 47% female; 84% white). Median time for CRAs to learn the system was 60 minutes (range, 30-240 minutes), and median time for CRAs to teach a patient to self-report was 10 minutes (range, 2-60 minutes). Compliance was high, particularly during active treatment, when patients self-reported at 86% of expected time points, although compliance was lower after treatment (72%). Common reasons for noncompliance were institutional errors, such as forgetting to provide computers to participants; patients missing clinic visits; Internet connectivity; and patients feeling “too sick.” Conclusions: Most patients enrolled in a multicenter chemoradiotherapy trial were willing and able to self-report symptomatic AEs at visits using tablet computers. Minimal effort was required by local site staff to support this system. The observed causes of missing data may be

  1. Implementation of mutual exclusion in VHDL

    NARCIS (Netherlands)

    Boersma, M.V.; Benders, L.P.M.; Stevens, M.P.J.; Wilsey, P.A.; Rhodes, D.

    1994-01-01

    In VHDL it is difficult to implement mutual exclusion at an abstract level since atomic actions are required. A local status model and an arbiter model are presented to achieve mutual exclusion in VHDL. Shared data, protected by a mutual exclusion mechanism, cannot be modelled as a simple, resolved

  2. Surfactant-aided size exclusion chromatography

    NARCIS (Netherlands)

    Horneman, D.A.; Wolbers, M.; Zomerdijk, M.; Ottens, M.; Keurentjes, J.T.F.; Wielen, van der L.A.M.

    2004-01-01

    The flexibility and selectivity of size exclusion chromatog. (SEC) for protein purifn. can be modified by adding non-ionic micelle-forming surfactants to the mobile phase. The micelles exclude proteins from a liq. phase similar to the exclusion effect of the polymer fibers of the size exclusion

  3. Size exclusion chromatography with superficially porous particles.

    Science.gov (United States)

    Schure, Mark R; Moran, Robert E

    2017-01-13

    A comparison is made using size-exclusion chromatography (SEC) of synthetic polymers between fully porous particles (FPPs) and superficially porous particles (SPPs) with similar particle diameters, pore sizes and equal flow rates. Polystyrene molecular weight standards with a mobile phase of tetrahydrofuran are utilized for all measurements conducted with standard HPLC equipment. Although it is traditionally thought that larger pore volume is thermodynamically advantageous in SEC for better separations, SPPs have kinetic advantages and these will be shown to compensate for the loss in pore volume compared to FPPs. The comparison metrics include the elution range (smaller with SPPs), the plate count (larger for SPPs), the rate production of theoretical plates (larger for SPPs) and the specific resolution (larger with FPPs). Advantages to using SPPs for SEC are discussed such that similar separations can be conducted faster using SPPs. SEC using SPPs offers similar peak capacities to that using FPPs but with faster operation. This also suggests that SEC conducted in the second dimension of a two-dimensional liquid chromatograph may benefit with reduced run time and with equivalently reduced peak width making SPPs advantageous for sampling the first dimension by the second dimension separator. Additional advantages are discussed for biomolecules along with a discussion of optimization criteria for size-based separations. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Exclusive scattering off the deuteron

    Energy Technology Data Exchange (ETDEWEB)

    Amrath, D.

    2007-12-15

    Exclusive processes are a special class of processes giving insight into the inner structure of hadrons. In this thesis we consider two exclusive processes and compute their total cross sections as well as the beam charge and beam polarization asymmetries for different kinematical constraints. These calculations o er the opportunity to get access to the nonperturbative GPDs. Theoretically they can be described with the help of models. The rst process we investigate contains a GPD of the pion, which is basically unknown so far. We include different models and make predictions for observables that could in principle be measured at HERMES at DESY and CLAS at JLab. The second process we consider is electron-deuteron scattering in the kinematical range where the deuteron breaks up into a proton and a neutron. This can be used to investigate the neutron, which cannot be taken as a target due to its lifetime of approximately 15 minutes. For the calculation of the electron-deuteron cross section we implement models for the proton and neutron GPDs. Once there are experimental data available our calculations are ready for comparison. (orig.)

  5. Clinical and Functional Impact of Hypogastric Artery Exclusion During EVAR.

    Science.gov (United States)

    Mansour, Wassim; Capoccia, Laura; Sirignano, Pasqualino; Montelione, Nunzio; Pranteda, Chiara; Formiconi, Martina; Sbarigia, Enrico; Speziale, Francesco

    2016-10-01

    Hypogastric artery (HA) revascularization during endovascular aneurysm repair (EVAR) is still open to debate. Moreover, exclusion-related complication rates reported in literature are not negligible. The aim of this study is to present and analyze the outcomes in patients undergoing EVAR with exclusion of 1 or both HAs at our academic center. We retrospectively reviewed our results in patients submitted to EVAR and needing HA exclusion, in terms of perioperative (30-day) and follow-up rates of intestinal and spinal cord ischemia, buttock claudication, buttock skin necrosis, and sexual dysfunction. From January 2008 to December 2014, a total of 527 patients underwent elective standard infrarenal EVAR; among those 104 (19.7%) had iliac involvement needing HA exclusion. In 73 patients with unilateral iliac involvement (70.1%, group UH), many single HAs were excluded. Thirty-one patients (29.9%) had bilateral iliac involvement (group BH), of which 16 (51.6%) had 1 HA excluded with revascularization of the contralateral one (group BHR); in the remaining 15 patients (48.4%) both HAs were excluded (group BHE). No 30-day or follow-up aneurysm-related mortality, intestinal, or spinal cord ischemia were recorded. At 30 days, skin necrosis was observed in 2 patients. Buttock claudication and sexual dysfunction rates were significantly greater in group BHE than in group BHR (P sexual dysfunction rates in group BHE were persistently higher than that in groups UH and BHR (P HA coil embolization was significantly associated with buttock claudication and sexual dysfunction (P HA should be salvaged in case of bilateral involvement. In case of unilateral HA exclusion, the rate of complications is not negligible. Coil embolization is related to a higher complication rate. © The Author(s) 2016.

  6. Retinal Structure Measurements as Inclusion Criteria for Stem Cell-Based Therapies of Retinal Degenerations.

    Science.gov (United States)

    Jacobson, Samuel G; Matsui, Rodrigo; Sumaroka, Alexander; Cideciyan, Artur V

    2016-04-01

    We reviewed and illustrated the most optimal retinal structural measurements to make in stem cell clinical trials. Optical coherence tomography (OCT) and autofluorescence (AF) imaging were used to evaluate patients with severe visual loss from nonsyndromic and syndromic retinitis pigmentosa (RP), ABCA4-Stargardt disease, and nonneovascular age-related macular degeneration (AMD). Outer nuclear layer (ONL), rod outer segment (ROS) layer, inner retina, ganglion cell layer (GCL), and nerve fiber layer (NFL) thicknesses were quantified. All patients had severely reduced visual acuities. Retinitis pigmentosa patients had limited visual fields; maculopathy patients had central scotomas with retained peripheral function. For the forms of RP illustrated, there was detectable albeit severely reduced ONL across the scanned retina, and normal or hyperthick GCL and NFL. Maculopathy patients had no measurable ONL centrally; it became detectable with eccentricity. Some maculopathy patients showed unexpected GCL losses. Autofluorescence imaging illustrated central losses of RPE integrity. A hypothetical scheme to relate patient data with different phases of retinal remodeling in animal models of retinal degeneration was presented. Stem cell science is advancing, but it is not too early to open the discussion of criteria for patient selection and monitoring. Available clinical tools, such as OCT and AF imaging, can provide inclusion/exclusion criteria and robust objective outcomes. Accepting that early trials may not lead to miraculous cures, we should be prepared to know why-scientifically and clinically-so we can improve subsequent trials. We also must determine if retinal remodeling is an impediment to efficacy.

  7. Ultrasound-guided percutaneous cholecysto-cholangiography for the exclusion of biliary atresia in infants

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Kyung Min; Ryeom, Hun Kyu; Choe, Byung Ho; Kim, Kap Cheol; Kim, Jong Yeol; Lee, Jong Min; Kim, Hye Jeong; Lee, Hee Jung [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2006-08-15

    The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice. Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings. The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient. Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder.

  8. Ultrasound-guided percutaneous cholecysto-cholangiography for the exclusion of biliary atresia in infants

    International Nuclear Information System (INIS)

    Shin, Kyung Min; Ryeom, Hun Kyu; Choe, Byung Ho; Kim, Kap Cheol; Kim, Jong Yeol; Lee, Jong Min; Kim, Hye Jeong; Lee, Hee Jung

    2006-01-01

    The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice. Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings. The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient. Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder

  9. Assessment by the patient of the acute toxicity of the pelvic radiotherapy according to the Common Terminology Criteria for Adverse Events, version 3.0 (CTCAE v3.0): dream or reality

    International Nuclear Information System (INIS)

    Champeaux-Orange, E.; Reynaud-Bougnoux, A.; Barillot, I.

    2010-01-01

    The Common Terminology Criteria for Adverse Events which contains a classification of radiotherapy side effects has been simplified and adapted into a notebook in order to make it clearer and easier to understand for the patient. The patients are given this notebook to fill it in on a daily basis. The authors report a survey which aimed at assessing the feasibility of using such a notebook to report the acute toxicity of pelvic radiotherapy. All the concerned patients filled in the notebook. A great majority of them filled it completely and every day. The rest of them filled in the notebook only on the days they had symptoms. Short communication

  10. Can axial-based nodal size criteria be used in other imaging planes to accurately determine "enlarged" head and neck lymph nodes?

    Science.gov (United States)

    Bartlett, Eric S; Walters, Thomas D; Yu, Eugene

    2013-01-01

    Objective. We evaluate if axial-based lymph node size criteria can be applied to coronal and sagittal planes. Methods. Fifty pretreatment computed tomographic (CT) neck exams were evaluated in patients with head and neck squamous cell carcinoma (SCCa) and neck lymphadenopathy. Axial-based size criteria were applied to all 3 imaging planes, measured, and classified as "enlarged" if equal to or exceeding size criteria. Results. 222 lymph nodes were "enlarged" in one imaging plane; however, 53.2% (118/222) of these were "enlarged" in all 3 planes. Classification concordance between axial versus coronal/sagittal planes was poor (kappa = -0.09 and -0.07, resp., P planes. Conclusion. Classification of "enlarged" lymph nodes differs between axial versus coronal/sagittal imaging planes when axial-based nodal size criteria are applied independently to all three imaging planes, and exclusively used without other morphologic nodal data.

  11. Scintigraphic criteria for administration of therapeutic activities of 131I for ablation of residual thyroid tissue in patients with differentiated thyroid cancer

    International Nuclear Information System (INIS)

    Dzhuzha, D.A.

    2003-01-01

    With the aim to determinate the optical scintigraphic criteria of radioablation of the small parts of residual thyroid tissue (RTT) after a thyroidectomy the results of postoperative monitoring of 29 women aged 23-60 with differentiated thyroid cancer, who did not get the radioiodine therapy, were analyzed. At the single postoperative scintigraphy with 131 I the optimal scintigraphic criteria for radioablation are the relative level of 131 I accumulation in RTT and the relative specific volume activity in RTT. At the values of these indices below 0.21% and 0.16%/sm 3 , respectively, only suppressive thyroid hormone therapy and standard monitoring are recommended

  12. Perspectives on the revised Ghent criteria for the diagnosis of Marfan syndrome

    Science.gov (United States)

    von Kodolitsch, Yskert; De Backer, Julie; Schüler, Helke; Bannas, Peter; Behzadi, Cyrus; Bernhardt, Alexander M; Hillebrand, Mathias; Fuisting, Bettina; Sheikhzadeh, Sara; Rybczynski, Meike; Kölbel, Tilo; Püschel, Klaus; Blankenberg, Stefan; Robinson, Peter N

    2015-01-01

    Three international nosologies have been proposed for the diagnosis of Marfan syndrome (MFS): the Berlin nosology in 1988; the Ghent nosology in 1996 (Ghent-1); and the revised Ghent nosology in 2010 (Ghent-2). We reviewed the literature and discussed the challenges and concepts of diagnosing MFS in adults. Ghent-1 proposed more stringent clinical criteria, which led to the confirmation of MFS in only 32%–53% of patients formerly diagnosed with MFS according to the Berlin nosology. Conversely, both the Ghent-1 and Ghent-2 nosologies diagnosed MFS, and both yielded similar frequencies of MFS in persons with a causative FBN1 mutation (90% for Ghent-1 versus 92% for Ghent-2) and in persons not having a causative FBN1 mutation (15% versus 13%). Quality criteria for diagnostic methods include objectivity, reliability, and validity. However, the nosology-based diagnosis of MFS lacks a diagnostic reference standard and, hence, quality criteria such as sensitivity, specificity, or accuracy cannot be assessed. Medical utility of diagnosis implies congruency with the historical criteria of MFS, as well as with information about the etiology, pathogenesis, diagnostic triggers, prognostic triggers, and potential complications of MFS. In addition, social and psychological utilities of diagnostic criteria include acceptance by patients, patient organizations, clinicians and scientists, practicability, costs, and the reduction of anxiety. Since the utility of a diagnosis or exclusion of MFS is context-dependent, prioritization of utilities is a strategic decision in the process of nosology development. Screening tests for MFS should be used to identify persons with MFS. To confirm the diagnosis of MFS, Ghent-1 and Ghent-2 perform similarly, but Ghent-2 is easier to use. To maximize the utility of the diagnostic criteria of MFS, a fair and transparent process of nosology development is essential. PMID:26124674

  13. Analysis of 2000 cases treated with gamma knife surgery: validating eligibility criteria for a prospective multi-institutional study of stereotactic radiosurgery alone for treatment of patients with 1-10 brain metastases (JLGK0901) in Japan

    Science.gov (United States)

    Higuchi, Yoshinori; Nagano, Osamu; Sato, Yasunori; Yamamoto, Masaaki; Ono, Junichi; Saeki, Naokatsu; Miyakawa, Akifumi; Hirai, Tatsuo

    2012-01-01

    Objective The Japan Leksell Gamma Knife (JLGK) Society has conducted a prospective multi-institute study (JLGK0901, UNIN000001812) for selected patients in order to prove the effectiveness of stereotactic radiosurgery (SRS) alone using the gamma knife (GK) for 1-10 brain lesions. Herein, we verify the validity of 5 major patient selection criteria for the JLGK0901 trial. Materials and Methods Between 1998 and 2010, 2246 consecutive cases with 10352 brain metastases treated with GK were analyzed to determine the validity of the following 5 major JLGK0901 criteria; 1) 1-10 brain lesions, 2) less than 10 cm3 volume of the largest tumor, 3) no more than 15 cm3 total tumor volume, 4) no cerebrospinal fluid (CSF) dissemination, 5) Karnofsky performance status (KPS) score ≥70. Results For cases with >10 brain metastases, salvage treatments for new lesions were needed more frequently. The tumor control rate for lesions larger than 10 cm3 was significantly lower than that of tumors 15 cm3 total tumor volume or positive magnetic resonance imaging findings of CSF were significantly poorer. Outcomes in cases with KPS <70 were significantly poorer in terms of OS. Conclusion Our retrospective results of 2246 GK-treated cases verified the validity of the 5 major JLGK0901 criteria. The inclusion criteria for the JLGK0901 study are appearently good indications for SRS. PMID:29296339

  14. Exclusive Breastfeeding Determinants in Breastfeeding Mother

    Directory of Open Access Journals (Sweden)

    Ika Mustika

    2017-04-01

    Full Text Available Exclusive breastfeeding until 6 month is very important for baby. The proportion of mothers who exclusively breastfeed their babies up to 6 months remains low. Factors influencing the exclusive breastfeeding namely sociodemograph factors , factors pre / post delivery , and psychosocial factors. This aims of this study to identify determinant factors of exclusive breastfeeding on mother. This research method is a systematic review , by analyzing the various studies on exclusive breastfeeding. There are 17 studies. The results obtained occupational factors most studied with significant results ( median OR = 1.265 . Psychosocial factors that have significant relationship is support of her husband (average OR = 4.716 and family support ( average OR = 1.770 . Conclusions : factors influencing the exclusive breastfeeding is occupational factor. Socialization and support from people nearby, health workers, and all parties is needed for exclusive breastfeeding for six months can be achieved.

  15. Exclusion of reticulocytosis as a cause of elevated mean ...

    African Journals Online (AJOL)

    Exclusion of reticulocytosis as a cause of elevated mean corpuscular volume in HIV patients on antiretroviral treatment in Zimbabwe. ... Several explanations have been made about the mechanisms and indications of macrocytosis but no study has been done in Zimbabwe to evaluate it. Aim: To investigate whether ...

  16. Modernizing Clinical Trial Eligibility Criteria: Recommendations of the American Society of Clinical Oncology–Friends of Cancer Research HIV Working Group

    Science.gov (United States)

    Uldrick, Thomas S.; Ison, Gwynn; Rudek, Michelle A.; Noy, Ariela; Schwartz, Karl; Bruinooge, Suanna; Schenkel, Caroline; Miller, Barry; Dunleavy, Kieron; Wang, Judy; Zeldis, Jerome; Little, Richard F.

    2018-01-01

    Purpose People with HIV are living longer as a result of effective antiretroviral therapy. Cancer has become a leading cause of morbidity and mortality in this patient population. However, studies of novel cancer therapeutics have historically excluded patients with HIV. Critical review of eligibility criteria related to HIV is required to accelerate development of and access to effective therapeutics for HIV-infected patients with cancer and make studies more generalizable to this patient population. Methods From January through April 2016, the HIV Working Group conducted a series of teleconferences; a review of 46 New Drug Applications from registration studies of unique agents studied in adults with cancer that led to the initial US Food and Drug Administration approval of that agent from 2011 to 2015; and a review of HIV-related eligibility criteria from National Cancer Institute–sponsored studies. Results were discussed and refined at a multistakeholder workshop held May 12, 2016. The HIV Working Group developed recommendations for eligibility criteria that focus on pharmacologic and immunologic considerations in this patient population and that balance patient safety, access to appropriate investigational agents, and study integrity. Results Exclusion of patients with HIV remains common in most studies of novel cancer agents. Models for HIV-related eligibility criteria in National Cancer Institute–sponsored studies are instructive. HIV infection itself should no longer be an exclusion criterion for most studies. Eligibility criteria related to HIV infection that address concurrent antiretroviral therapy and immune status should be designed in a manner that is appropriate for a given cancer. Conclusion Expanding clinical trial eligibility to be more inclusive of patients with HIV is justified in most cases and may accelerate the development of effective therapies in this area of unmet clinical need. PMID:28968173

  17. Modernizing Clinical Trial Eligibility Criteria: Recommendations of the American Society of Clinical Oncology-Friends of Cancer Research HIV Working Group.

    Science.gov (United States)

    Uldrick, Thomas S; Ison, Gwynn; Rudek, Michelle A; Noy, Ariela; Schwartz, Karl; Bruinooge, Suanna; Schenkel, Caroline; Miller, Barry; Dunleavy, Kieron; Wang, Judy; Zeldis, Jerome; Little, Richard F

    2017-11-20

    Purpose People with HIV are living longer as a result of effective antiretroviral therapy. Cancer has become a leading cause of morbidity and mortality in this patient population. However, studies of novel cancer therapeutics have historically excluded patients with HIV. Critical review of eligibility criteria related to HIV is required to accelerate development of and access to effective therapeutics for HIV-infected patients with cancer and make studies more generalizable to this patient population. Methods From January through April 2016, the HIV Working Group conducted a series of teleconferences; a review of 46 New Drug Applications from registration studies of unique agents studied in adults with cancer that led to the initial US Food and Drug Administration approval of that agent from 2011 to 2015; and a review of HIV-related eligibility criteria from National Cancer Institute-sponsored studies. Results were discussed and refined at a multistakeholder workshop held May 12, 2016. The HIV Working Group developed recommendations for eligibility criteria that focus on pharmacologic and immunologic considerations in this patient population and that balance patient safety, access to appropriate investigational agents, and study integrity. Results Exclusion of patients with HIV remains common in most studies of novel cancer agents. Models for HIV-related eligibility criteria in National Cancer Institute-sponsored studies are instructive. HIV infection itself should no longer be an exclusion criterion for most studies. Eligibility criteria related to HIV infection that address concurrent antiretroviral therapy and immune status should be designed in a manner that is appropriate for a given cancer. Conclusion Expanding clinical trial eligibility to be more inclusive of patients with HIV is justified in most cases and may accelerate the development of effective therapies in this area of unmet clinical need.

  18. Biological Water Quality Criteria

    Science.gov (United States)

    Page contains links to Technical Documents pertaining to Biological Water Quality Criteria, including, technical assistance documents for states, tribes and territories, program overviews, and case studies.

  19. Prospective testing of ICHD-3 beta diagnostic criteria for migraine with aura and migraine with typical aura in patients with transient ischemic attacks

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Gurary, Natalia M; Gilev, Denis V

    2018-01-01

    Introduction The International Classification of Headache Disorders 3rd edition beta (ICHD-3 beta) gave alternative diagnostic criteria for 1.2 migraine with aura (MA) and 1.2.1 migraine with typical aura (MTA) in the appendix. The latter were presumed to better differentiate transient ischemic...

  20. The use of multi-criteria decision analysis weight elicitation techniques in patients with mild cognitive impairment: a pilot study.

    Science.gov (United States)

    van Til, Janine A; Dolan, James G; Stiggelbout, Anne M; Groothuis, Karin C G M; Ijzerman, Maarten J

    2008-04-01

    To test the applicability of multi-criteria decision analysis preference elicitation techniques in cognitively impaired individuals. A convenience sample of 16 cognitively impaired subjects and 12 healthy controls was asked to participate in a small pilot study. The subjects determined the relative importance of four decision criteria using five different weight elicitation techniques, namely simple multi-attribute rating technique, simple multi-attribute rating technique using swing weights, Kepner-Tregoe weighting, the analytical hierarchical process, and conjoint analysis. Conjoint analysis was judged to be the easiest method for weight elicitation in the control group (Z = 10.00; p = 0.04), while no significant differences in difficulty rating between methods was found in cognitively impaired subjects. Conjoint analysis elicitates weights and rankings significantly different from other methods. Subjectively, cognitively impaired subjects were positive about the use of the weight elicitation techniques. However, it seems the use of swing weights can result in the employment of shortcut strategies. The results of this pilot study suggest that individuals with mild cognitive impairment are willing and able to use multi-criteria elicitation methods to determine criteria weights in a decision context, although no preference for a method was found. The same methodologic and practical issues can be identified in cognitively impaired individuals as in healthy controls and the choice of method is mostly determined by the decision context.

  1. Are symptoms of spirit possessed patients covered by the DSM-IV or DSM-5 criteria for possession trance disorder? A mixed-method explorative study in Uganda

    NARCIS (Netherlands)

    van Duijl, M.; Kleyn, W.; de Jong, J.

    2013-01-01

    Introduction and aims As in many cultures, spirit possession is a common idiom of distress in Uganda. The DSM-IV contains experimental research criteria for dissociative and possession trance disorder (DTD and PTD), which are under review for the DSM-5. In the current proposed categories of the

  2. 2012 Provisional classification criteria for polymyalgia rheumatica

    DEFF Research Database (Denmark)

    Dasgupta, Bhaskar; Cimmino, Marco A; Kremers, Hilal Maradit

    2012-01-01

    The objective of this study was to develop European League Against Rheumatism/American College of Rheumatology classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new-onset PMR and 169 non-PMR compa...

  3. 2012 provisional classification criteria for polymyalgia rheumatica

    DEFF Research Database (Denmark)

    Dasgupta, Bhaskar; Cimmino, Marco A; Maradit-Kremers, Hilal

    2012-01-01

    The objective of this study was to develop EULAR/ACR classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring al...

  4. Repository operational criteria analysis

    International Nuclear Information System (INIS)

    Hageman, J.P.; Chowdhury, A.H.

    1992-08-01

    The objective of the ''Repository Operational Criteria (ROC) Feasibility Studies'' (or ROC task) was to conduct comprehensive and integrated analyses of repository design, construction, and operations criteria in 10 CFR Part 60 regulations, considering the interfaces and impacts of any potential changes to those regulations. The study addresses regulatory criteria related to the preclosure aspects of the geologic repository. The study task developed regulatory concepts or potential repository operational criteria (PROC) based on analysis of a repository's safety functions and other regulations for similar facilities. These regulatory concepts or PROC were used as a basis to assess the sufficiency and adequacy of the current criteria in 10 CFR Part 60. Where the regulatory concepts were same as current operational criteria, these criteria were referenced. The operations criteria referenced or the PROC developed are given in this report. Detailed analyses used to develop the regulatory concepts and any necessary PROC for those regulations that may require a minor change are also presented. The results of the ROC task showed a need for further analysis and possible major rule change related to the design bases of a geologic repository operations area, siting, and radiological emergency planning

  5. CCS site characterisation criteria

    Energy Technology Data Exchange (ETDEWEB)

    Bachu, S.; Hawkes, C.; Lawton, D.; Pooladi-Darvish, M.; Perkins, E.

    2009-12-15

    IEA GHG recently commissioned the Alberta Research Counil in Canada to conduct a review of storage site selection criteria and site characterisation methods in order to produce a synthesis report. This report reviews the literature on the subject on the site seleciton and characterisation since the publication of the IPCC Special Report on CCS, and provides a synthesis and classification of criteria. 161 refs.

  6. Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage.

    Science.gov (United States)

    Tusgul, Selin; Carron, Pierre-Nicolas; Yersin, Bertrand; Calandra, Thierry; Dami, Fabrice

    2017-11-03

    Sepsis is defined as life-threatening organ dysfunction caused by a host response to infection. The quick SOFA (qSOFA) score has been recently proposed as a new bedside clinical score to identify patients with suspected infection at risk of complication (intensive care unit (ICU) admission, in-hospital mortality). The aim of this study was to measure the sensitivity of the qSOFA score, SIRS criteria and sepsis definitions to identify the most serious sepsis cases in the prehospital setting and at the emergency department (ED) triage. We performed a retrospective study of all patients transported by emergency medical services (EMS) to the Lausanne University Hospital (CHUV) over twelve months. All patients with a suspected or proven infection after the ED workup were included. We retrospectively analysed the sensitivity of the qSOFA score (≥2 criteria), SIRS criteria (≥2 clinical criteria) and sepsis definition (SIRS criteria + one sign of organ dysfunction or hypoperfusion) in the pre-hospital setting and at the ED triage as predictors of ICU admission, ICU stay of ≥3 days and early (i.e. 48 h) mortality. No direct comparison between the three tools was attempted. Among 11,411 patients transported to the University hospital, 886 (7.8%) were included. In the pre-hospital setting, the sensitivity of qSOFA reached 36.3% for ICU admission, 17.4% for ICU stay of three days or more and 68.0% for 48 h mortality. The sensitivity of SIRS criteria reached 68.8% for ICU admission, 74.6% for ICU stay of three days or more and 64.0% for 48 h mortality. The sensitivity of sepsis definition did not reach 60% for any outcome. At ED triage, the sensitivity of qSOFA reached 31.2% for ICU admission, 30.5% for ICU stay of ≥3 days and 60.0% for mortality at 48 h. The sensitivity of SIRS criteria reached 58.8% for ICU admission, 57.6% for ICU stay of ≥3 days 80.0% for mortality at 48 h. The sensitivity of sepsis definition reached 60.0% for 48 h mortality. Incidence

  7. [Evaluation of the status of patients with severe infection, criteria for intensive care unit admittance. Spanish Society for Infectious Diseases and Clinical Microbiology. Spanish Society of Intensive and Critical Medicine and Coronary Units].

    Science.gov (United States)

    Olaechea, Pedro M; Alvarez-Lerma, Francisco; Sánchez, Miguel; Torres, Antonio; Palomar, Mercedes; Fernández, Pedro; Miró, José M; Cisneros, José Miguel; Torres, Manuel

    2009-06-01

    Recent studies have shown that early attention in patients with serious infections is associated with a better outcome. Assistance in intensive care units (ICU) can effectively provide this attention; hence patients should be admitted to the ICU as soon as possible, before clinical deterioration becomes irreversible. The objective of this article is to compile the recommendations for evaluating disease severity in patients with infections and describe the criteria for ICU admission, updating the criteria published 10 years ago. A literature review was carried out, compiling the opinions of experts from the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC, Spanish Society for Infectious Diseases and Clinical Microbiology) and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC, Spanish Society for Intensive Medicine, Critical Care and Coronary Units) as well as the working groups for infections in critically ill patients (GEIPC-SEIMC and GTEI-SEMICYUC). We describe the specific recommendations for ICU admission related to the most common infections affecting patients, who will potentially benefit from critical care. Assessment of the severity of the patient's condition to enable early intensive care is stressed.

  8. Green Supplier Selection Criteria

    DEFF Research Database (Denmark)

    Nielsen, Izabela Ewa; Banaeian, Narges; Golinska, Paulina

    2014-01-01

    Green supplier selection (GSS) criteria arise from an organization inclination to respond to any existing trends in environmental issues related to business management and processes, so GSS is integrating environmental thinking into conventional supplier selection. This research is designed...... to determine prevalent general and environmental supplier selection criteria and develop a framework which can help decision makers to determine and prioritize suitable green supplier selection criteria (general and environmental). In this research we considered several parameters (evaluation objectives......) to establish suitable criteria for GSS such as their production type, requirements, policy and objectives instead of applying common criteria. At first a comprehensive and deep review on prevalent and green supplier selection literatures performed. Then several evaluation objectives defined to assess the green...

  9. Plutonium storage criteria

    Energy Technology Data Exchange (ETDEWEB)

    Chung, D. [Scientech, Inc., Germantown, MD (United States); Ascanio, X. [Dept. of Energy, Germantown, MD (United States)

    1996-05-01

    The Department of Energy has issued a technical standard for long-term (>50 years) storage and will soon issue a criteria document for interim (<20 years) storage of plutonium materials. The long-term technical standard, {open_quotes}Criteria for Safe Storage of Plutonium Metals and Oxides,{close_quotes} addresses the requirements for storing metals and oxides with greater than 50 wt % plutonium. It calls for a standardized package that meets both off-site transportation requirements, as well as remote handling requirements from future storage facilities. The interim criteria document, {open_quotes}Criteria for Interim Safe Storage of Plutonium-Bearing Solid Materials{close_quotes}, addresses requirements for storing materials with less than 50 wt% plutonium. The interim criteria document assumes the materials will be stored on existing sites, and existing facilities and equipment will be used for repackaging to improve the margin of safety.

  10. Evaluating Dependence Criteria for Caffeine.

    Science.gov (United States)

    Striley, Catherine L W; Griffiths, Roland R; Cottler, Linda B

    2011-12-01

    Background: Although caffeine is the most widely used mood-altering drug in the world, few studies have operationalized and characterized Diagnostic and Statistical Manual IV (DSM-IV) substance dependence criteria applied to caffeine. Methods: As a part of a nosological study of substance use disorders funded by the National Institute on Drug Abuse, we assessed caffeine use and dependence symptoms among high school and college students, drug treatment patients, and pain clinic patients who reported caffeine use in the last 7 days and also reported use of alcohol, nicotine, or illicit drugs within the past year ( n =167). Results: Thirty-five percent met the criteria for dependence when all seven of the adopted DSM dependence criteria were used. Rates of endorsement of several of the most applicable diagnostic criteria were as follows: 26% withdrawal, 23% desire to cut down or control use, and 44% continued use despite harm. In addition, 34% endorsed craving, 26% said they needed caffeine to function, and 10% indicated that they talked to a physician or counselor about problems experienced with caffeine. There was a trend towards increased caffeine dependence among those dependent on nicotine or alcohol. Within a subgroup that had used caffeine, alcohol, and nicotine in the past year, 28% fulfilled criteria for caffeine dependence compared to 50% for alcohol and 80% for nicotine. Conclusion: The present study adds to a growing literature suggesting the reliability, validity, and clinical utility of the caffeine dependence diagnosis. Recognition of caffeine dependence in the DSM-V may be clinically useful.

  11. 27 CFR 6.153 - Criteria for determining retailer independence.

    Science.gov (United States)

    2010-04-01

    ... AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS âTIED-HOUSEâ Exclusion § 6.153 Criteria for... or the quantity in which to purchase them for sale to consumers. (b) The industry member obligates the retailer to participate in the promotion to obtain the industry member's product. (c) The retailer...

  12. Prevalence and Features of a Probable Diagnosis in First-Visit Headache Patients Based on the Criteria of the Third Beta Edition of the International Classification of Headache Disorders: A Prospective, Cross-Sectional Multicenter Study.

    Science.gov (United States)

    Kim, Soo-Kyoung; Moon, Heui-Soo; Cha, Myong-Jin; Kim, Byung-Su; Kim, Byung-Kun; Park, Jeong-Wook; Park, Kwang-Yeol; Sohn, Jong-Hee; Chu, Min-Kyung; Song, Tae-Jin; Kim, Jae-Moon; Cho, Soo-Jin

    2016-02-01

    This study aimed to determine the characteristics and significance of a probable diagnostic entity for primary headache disorder (PHD). A diagnosis of probable primary headache disorder (PPHD) is given when a patient's headache fulfills all but one criteria of the third beta edition of the international classification of headache disorder (ICHD-3β). Despite the uncertainty regarding this diagnosis, the inclusion of a probable diagnosis entity in this manual may aid in the accurate classification of headache disorders and allow effective treatment strategies to be started at the patient's initial visit. This cross-sectional multicenter registry study assessed first-visit patients with complaints of headaches who presented at the outpatient clinics of 11 neurologists in Korea. The classification of a headache disorder was made according to the criteria of the ICHD-3β by each investigator based on the initial evaluation of the patient or by a consensus meeting for uncertain cases. The rates of a probable diagnosis among PPHD patients were assessed and the clinical characteristics of these patients were compared with those of patients with a diagnosis of definite primary headache disorder (DPHD). A total of 1429 patients were diagnosed with PHD, and 305 (21.3%) of these patients had PPHD. The proportions of PPHD differed among the subtypes of DPHD as follows: migraines (16.1%), tension-type headaches (TTH; 33%), trigeminal autonomic cephalalgia (TAC; 40.9%), and other PHD (14%, P headache intensity than patients with DPHD (5.8 ± 2.2 vs. 6.5 ± 2.1, respectively, P headache from onset (median: 1 vs. 4 months, respectively, P headaches. The incorporation of a probable diagnosis into the ICHD-3β may be useful for reducing the diagnoses of unspecified headaches. © 2016 American Headache Society.

  13. Diagnostic performance of Baveno IV criteria in cirrhotic patients with upper gastrointestinal bleeding: analysis of the F7 liver-1288 study population

    DEFF Research Database (Denmark)

    Thabut, D; D'Amico, G; Tan, P

    2010-01-01

    The definition of failure to control bleeding agreed upon at the Baveno IV consensus meeting, included the Adjusted Blood Requirement Index [ABRI: number of blood units/(final-initial hematocrit+0.01)]. ABRI =0.75 denotes failure. However, timing for hematocrit measurements was not defined....... The aims of this study were: (1) to assess the Baveno IV criteria performance to classify treatment success or failure to control bleeding at 5 days, (2) to determine the appropriate timing for hematocrit....

  14. Diagnostic performance of Baveno IV criteria in cirrhotic patients with upper gastrointestinal bleeding: analysis of the F7 liver-1288 study population

    DEFF Research Database (Denmark)

    Thabut, D; D'Amico, G; Tan, P

    2010-01-01

    The definition of failure to control bleeding agreed upon at the Baveno IV consensus meeting, included the Adjusted Blood Requirement Index [ABRI: number of blood units/(final-initial hematocrit+0.01)]. ABRI ≥0.75 denotes failure. However, timing for hematocrit measurements was not defined....... The aims of this study were: (1) to assess the Baveno IV criteria performance to classify treatment success or failure to control bleeding at 5 days, (2) to determine the appropriate timing for hematocrit....

  15. Exclusive Higgs production at the LHC

    Energy Technology Data Exchange (ETDEWEB)

    Dechambre, Alice [Universite de Liege, Institut d' Astrophysique et de Geophysique, Allee du 6 aout, 17 - Bat. B5c, B-4000 Liege 1 - Sart-Tilman (Belgium); Staszewski, Rafal [IRFU/SPP, CEA-Saclay, bat. 141, 91191 Gif-sur-Yvette Cedex (France); Henryk Niewodniczanski, Institute of Nuclear Physics - PAN, Polish Academy of Sciences, ul. Radzikowskiego 152, 31-342 Krakow (Poland); Royon, Christophe [IRFU/SPP, CEA-Saclay, bat. 141, 91191 Gif-sur-Yvette Cedex (France)

    2010-07-01

    After a brief description of the models of exclusive diffractive Higgs production, we first evaluate the theoretical uncertainties that affect the calculation of exclusive cross section (jets, Higgs...). In addition, in view of the recent measurement of exclusive di-jet at CDF and the new implementation of the corresponding cross section in FPMC (Forward Physics Monte-Carlo), we developed an analysis strategy that can be used to narrow down these uncertainties with the help of early LHC measurement. (authors)

  16. Negotiations and Exclusivity Contracts for Advertising

    OpenAIRE

    Anthony Dukes; Esther Gal–Or

    2003-01-01

    Exclusive advertising on a given media outlet is usually profitable for an advertiser because consumers are less aware of competing products. However, for such arrangements to exist, media must benefit as well. We examine conditions under which such exclusive advertising contracts benefit both advertisers and media outlets (referred to as ) by illustrating that exclusive equilibria arise in a theoretical model of the media, advertisers, and consumers who participate in both the product and me...

  17. Demographic and clinical aspects of an Italian patient population with chronic fatigue syndrome

    Directory of Open Access Journals (Sweden)

    N. Carlo-Stella

    2011-06-01

    Full Text Available Chronic Fatigue Syndrome (CFS is a debilitating syndrome characterized by fatigue which, by exclusion, cannot be ascribed to another illness. Because of the vagueness of the symptoms and signs in patients with CFS, various attempts have been made to define the syndrome and classification criteria have been developed (1- 3, of which the most well-known and used are those of Fukuda et al. (1 This classification includes two major criteria...

  18. Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

    OpenAIRE

    Jason, Leonard A; McManimen, Stephanie; Sunnquist, Madison; Newton, Julia L; Strand, Elin Bolle

    2017-01-01

    The Institute of Medicine (IOM) recently developed clinical criteria for chronic fatigue syndrome (CFS). There might be additional criteria that could select a more homogenous and impaired group of patients, particularly those with pain. The current study focused on criteria which involved meeting the four IOM criteria, excluding medical and psychiatric co-morbidities, along with having fibromyalgia (FM). Findings indicated that those meeting the IOM clinical criteria plus FM were more impair...

  19. Inclusive education and social exclusion

    Directory of Open Access Journals (Sweden)

    Maria Luisa Bissoto

    2013-01-01

    Full Text Available The aim of this paper is critically examining assumptions underlying the Inclusive Education concept, arguing that this can only be effectively considered when understood in a broader context of social inclusion and exclusion. Methodologically, this article relies on international documents and bibliographic references about Inclusive Education, that have been chosen by systematize and characterize different social and educational inclusive practices, encouraging the elaboration of a general overview on this topic. The results of this analysis conclude that it is essential for Inclusive Education that educational institutions review their goals and reasons of social existence. In the concluding remarks it is argued that education is better understood as the act of encouraging and welcoming the efforts of individuals in their attempts to engage in social networking, which sustains life. This includes the acceptance of other reality interpretations and understanding that educational action cannot be restricted by the walls of institutions. It requires the participation of the whole community. Action perspectives likely to promote social inclusion and inclusive education are suggested.

  20. Perturbative QCD and exclusive processes

    International Nuclear Information System (INIS)

    Bennett, J.; Hawes, F.; Zhao, M.; Zyla, P.

    1991-01-01

    The authors discuss perturbation theory as applied to particle physics calculations. In particle physics one is generally interested in the scattering amplitude for a system going from some initial state to a final state. The intermediate state or states are unknown. To get the scattering amplitude it is necessary to sum the contributions from processes which pass through all possible intermediate states. Intermediate states involve the exchange of intermediate vector bosons between the particles, and with this interaction is associated a coupling constant α. Each additional boson exchange involves an additional contribution of α to the coupling. If α is less than 1, one can see that the relative contribution of higher order processes is less and less important as α falls. In QCD the gluons serve as the intermediate vector bosons exchanged by quarks and gluons, and the interaction constant is not really a constant, but depends upon the distance between the particles. At short distances the coupling is small, and one can assume perturbative expansions may converge rapidly. Exclusive scattering processes, as opposed to inclusive, are those in which all of the final state products are detected. The authors then discuss the application of perturbative QCD to the deuteron. The issues of chiral conservation and color transparancy are also discussed, in the scheme of large Q 2 interations, where perturbative QCD should be applicable

  1. Exclusive processes in pp collisions in CMS

    OpenAIRE

    da Silveira, Gustavo G.; Collaboration, for the CMS

    2013-01-01

    We report the results on the searches of exclusive production of low- and high-mass pairs with the Compact Muon Solenoid (CMS) detector in proton-proton collisions at $\\sqrt{s}$ = 7 TeV. The analyses comprise the central exclusive $\\gamma\\gamma$ production, the exclusive two-photon production of dileptons, $e^{+}e^{-}$ and $\\mu^{+}\\mu^{-}$, and the exclusive two-photon production of $W$ pairs in the asymmetric $e^{\\pm}\\mu^{\\mp}$ decay channel. No diphotons candidates are observed in data and ...

  2. Patient phenotypes in fibromyalgia comorbid with systemic sclerosis or rheumatoid arthritis: influence of diagnostic and screening tests. Screening with the FiRST questionnaire, diagnosis with the ACR 1990 and revised ACR 2010 criteria.

    Science.gov (United States)

    Perrot, Serge; Peixoto, Mariana; Dieudé, Philippe; Hachulla, Eric; Avouac, Jerome; Ottaviani, Sebastien; Allanore, Yannick

    2017-01-01

    Fibromyalgia (FM) may occur with rheumatoid arthritis (RA) and systemic sclerosis (SSc), and debate remains about its diagnosis. We aimed to use three FM tools (a screening tool (FiRST), diagnostic criteria (ACR 1990 and revised 2010), to compare FM prevalence between RA and SSc patients, to describe the phenotypes of patients with comorbid FM, and to analyze links between FM and secondary Sjögren's syndrome (SS). Consecutive adult patients with confirmed RA or SSc from four university hospitals were tested with the three FM tools. FiRST detected FM in 22.6% of the 172 RA patients, with confirmation in 22.1% (ACR1990) and 19.1% (ACR2010). ACR1990FM+ RA patients had more diffuse pain, whereas ACR2010FM+ RA patients had higher BMI and pain intensity, more diffuse pain, active disease, disability, and associated SS. FiRST detected FM in 27.8% of the 122 SSc patients, with confirmation in 30.3% (ACR1990) and 23.7% (ACR2010). ACR1990FM+ SSc patients had greater disability and pain intensity, and more diffuse pain, whereas ACR2010FM+ SSc patients had higher BMI, pain intensity, more disability and diffuse pain, and associated SS. Correlations between FM diagnostic and screening tool results were modest in both conditions. Secondary SS was associated with comorbid FM. The prevalence of FM is high in SSc and RA, whatever the FM diagnostic tool used. Secondary SS is associated with FM in both RA and SSc. The revised ACR 2010 FM criteria and FiRST screening tool reveal specific phenotypes potentially useful for improving disease management.

  3. Measuring social exclusion in healthcare settings: a scoping review.

    Science.gov (United States)

    O'Donnell, Patrick; O'Donovan, Diarmuid; Elmusharaf, Khalifa

    2018-02-02

    Social exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health. The meanings of the phrase "social exclusion", and the closely associated term "social inclusion", are contested in the literature. Both of these concepts are important in relation to health and the area of primary healthcare in particular. Thus, several tools for the measurement of social exclusion or social inclusion status in health care settings have been developed. A scoping review of the peer-reviewed and grey literature was conducted to examine tools developed since 2000 that measure social exclusion or social inclusion. We focused on those measurement tools developed for use with individual patients in healthcare settings. Efforts were made to obtain a copy of each of the original tools, and all relevant background literature. All tools retrieved were compared in tables, and the specific domains that were included in each measure were tabulated. Twenty-two measurement tools were included in the final scoping review. The majority of these had been specifically developed for the measurement of social inclusion or social exclusion, but a small number were created for the measurement of other closely aligned concepts. The majority of the tools included were constructed for engaging with patients in mental health settings. The tools varied greatly in their design, the scoring systems and the ways they were administered. The domains covered by these tools varied widely and some of the tools were quite narrow in the areas of focus. A review of the definitions of both social inclusion and social exclusion also revealed the variations among the explanations of these complex concepts. There are several definitions of both social inclusion and social exclusion in use and they differ greatly in scope. While there are many tools that have been developed for measuring these concepts in healthcare settings, these

  4. Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia.

    Science.gov (United States)

    Jason, Leonard A; McManimen, Stephanie; Sunnquist, Madison; Newton, Julia L; Strand, Elin Bolle

    2017-01-01

    The Institute of Medicine (IOM) recently developed clinical criteria for chronic fatigue syndrome (CFS). There might be additional criteria that could select a more homogenous and impaired group of patients, particularly those with pain. The current study focused on criteria which involved meeting the four IOM criteria, excluding medical and psychiatric co-morbidities, along with having fibromyalgia (FM). Findings indicated that those meeting the IOM clinical criteria plus FM were more impaired on a wide variety of symptoms and functional areas than those meeting on the IOM criteria or those with just 6 months of fatigue. The implications of using such research criteria are discussed.

  5. XCone. N-jettiness as an Exclusive Cone Jet Algorithm

    International Nuclear Information System (INIS)

    Stewart, Iain W.; Thaler, Jesse; Wilkason, Thomas F.; Tackmann, Frank J.; Vermilion, Christopher K.

    2015-08-01

    We introduce a new jet algorithm called XCone, for eXclusive Cone, which is based on minimizing the event shape N-jettiness. Because N-jettiness partitions every event into N jet regions and a beam region, XCone is an exclusive jet algorithm that always returns a fixed number of jets. We use a new ''conical geometric'' measure for which well-separated jets are bounded by circles of radius R in the rapidity-azimuth plane, while overlapping jet regions automatically form nearest-neighbor ''clover jets''. This avoids the split/merge criteria needed in inclusive cone algorithms. A key feature of XCone is that it smoothly transitions between the resolved regime where the N signal jets of interest are well separated and the boosted regime where they overlap. The returned value of N-jettiness also provides a quality criterion of how N-jet-like the event looks. We also discuss the N-jettiness factorization theorems that occur for various jet measures, which can be used to compute the associated exclusive N-jet cross sections. In a companion paper, the physics potential of XCone is demonstrated using the examples of dijet resonances, Higgs decays to bottom quarks, and all-hadronic top pairs.

  6. Justice and Immigration: The Effect of Moral Exclusion

    Directory of Open Access Journals (Sweden)

    Stefano Passini

    2018-02-01

    Full Text Available Numerous media news items suggest on a daily basis that people tend to use harsher criteria when they judge immigrants than members of their own in-group. In the present research project, we were interested in studying individual justice judgments of a violation of a law by an Italian (in-group or an immigrant (out-group member and the influence of moral exclusion processes on the assessment. In particular, we examined whether those people who tend to exclude out-groups from their scope of justice will give such biased judgments and will adopt double standards, while inclusive people will not. A total of 255 people evaluated the seriousness of a crime in two different law-breaking scenarios in which the offender’s and the victim’s nationalities were systematically changed (either Italian or Romanian. Moreover, participants completed a scale measuring the moral inclusion/exclusion of other social groups. As hypothesized, participants who tended to exclude some groups from their moral community judged the Romanian more harshly than the Italian culprit. On the contrary, those people that tended to have a more inclusive moral community did not show any difference in evaluation. In conclusion, the present research highlights the importance of considering the effect of moral inclusion/exclusion processes on the evaluation of justice events, especially in an intergroup context.

  7. Colonic exclusion and combined therapy for refractory constipation.

    Science.gov (United States)

    Peng, Hong-Yun; Xu, Ai-Zhong

    2006-12-28

    To investigate the therapeutic effectiveness of colonic exclusion and combined therapy for refractory constipation. Thirty-two patients with refractory constipation were randomly divided into treatment group (n = 14) and control group (n = 18). Fourteen patients in treatment group underwent colonic exclusion and end-to-side colorectal anastomosis. Eighteen patients in control group received subtotal colectomy and end-to-end colorectal anastomosis. The therapeutic effects of the operations were assessed by comparing the surgical time, incision length, volume of blood losses, hospital stay, recovery rate and complication incidence. All patients received long-term follow-up. All operations were successful and patients recovered fully after the operations. In comparison of treatment group and control group, the surgical time (h), incision length (cm), volume of blood losses (mL), hospital stay (d) were 87 +/- 16 min vs 194 +/- 23 min (t = 9.85), 10.4 +/- 0.5 cm vs 21.2 +/- 1.8 cm (t = 14.26), 79.5 +/- 31.3 mL vs 286.3 +/- 49.2 mL (t = 17.24), and 11.8 +/- 2.4 d vs 18.6 +/- 2.6 d (t = 6.91), respectively (P 0.05), 21.4% vs 33.3% (P = 0.73 > 0.05), respectively. Colonic exclusion has better therapeutic efficacy on refractory constipation. It has many advantages such as shorter surgical time, smaller incision, fewer blood losses and shorter hospital stay.

  8. [ The new 2010 Ghent criteria for the indication to surgical treatment of patients affected by Marfan syndrome. Experience of a single cardiac surgery center].

    Science.gov (United States)

    Grego, Susanna; Nardi, Paolo; Gislao, Valentina; Nicolò, Francesca; D'Annolfo, Antonella; Marcucci, Rosaria; Bovio, Emanuele; Versaci, Francesco; Chiariello, Luigi

    2013-01-01

    The diagnosis and surgical treatment of patients with Marfan syndrome remain controversial. It is of utmost importance to identify patients at risk for acute aortic events to establish the correct surgical timing and the appropriate surgical treatment. From May 2008 to December 2012, 500 patients were screened at the Marfan Presidium of the Tor Vergata University Hospital of Rome (Italy). Patients were evaluated by a cardiac surgeon, including echocardiographic, orthopedic, ophthalmologic and dental examinations. All patients received genetic counseling, and genetic sampling was performed if appropriate. The diagnosis of Marfan syndrome was confirmed in 146 patients (29.2%). Fifty-four patients (37%) underwent cardiac surgery on the aortic root, 4 patients had surgery on the mitral valve, 13 patients had combined surgery; 11 cases were emergent surgery for acute aortic dissection. Twenty-eight patients (52%) were operated on at our Division: 13 underwent valve-sparing aortic root replacement (David procedure), 1 underwent Yacoub remodeling procedure and 14 underwent Bentall procedure. Following the establishment of the Marfan Center, the David aortic valve-sparing operation was the most frequently performed procedure compared to the previous period of surgical activity (63 vs 22%, psyndromes. Early surgical treatment is recommended in these patients to achieve optimal results of valve-sparing procedures and life-saving management, especially for patients who live far away from a cardiac surgery center.

  9. Multimodal freight investment criteria.

    Science.gov (United States)

    2010-07-01

    Literature was reviewed on multi-modal investment criteria for freight projects, examining measures and techniques for quantifying project benefits and costs, as well as ways to describe the economic importance of freight transportation. : A limited ...

  10. Water Quality Criteria

    Science.gov (United States)

    EPA develops water quality criteria based on the latest scientific knowledge to protect human health and aquatic life. This information serves as guidance to states and tribes in adopting water quality standards.

  11. Aquatic Life Criteria - Ammonia

    Science.gov (United States)

    Documents related to EPA's final 2013 Aquatic Life Ambient Water Quality Criteria for Ammonia (Freshwater). These documents pertain to the safe levels of Ammonia in water that should protect to the majority of species.

  12. Aquatic Life Criteria - Copper

    Science.gov (United States)

    Documents pertain to Aquatic Life Ambient Water Quality criteria for Copper (2007 Freshwater, 2016 Estuarine/marine). These documents contain the safe levels of Copper in water that should protect to the majority of species.

  13. Integrated Criteria Document Chromium

    NARCIS (Netherlands)

    Slooff W; Cleven RFMJ; Janus JA; van der Poel P; van Beelen P; Boumans LJM; Canton JH; Eerens HC; Krajnc EI; de Leeuw FAAM; Matthijsen AJCM; van de Meent D; van der Meulen A; Mohn GR; Wijland GC; de Bruijn PJ; van Keulen A; Verburgh JJ; van der Woerd KF

    1990-01-01

    Betreft de engelse versie van rapport 758701001
    Bij dit rapport behoort een appendix onder hetzelfde nummer getiteld: "Integrated Criteria Document Chromium: Effects" Auteurs: Janus JA; Krajnc EI
    (appendix: see 710401002A)

  14. Comparative study between kidney transplantation with deceased donor expanded criteria and donor standard criteria in a single center in Brazil.

    Science.gov (United States)

    Mota, Luana Soriano; Oliveira, Claudia Maria Costa de; Pinheiro, Francisco Martho Leal; Santos, Larissa Costa de Oliveira; Nóbrega, Danilo Gonçalves; Fernandes, Paula Fbc; Costa, Alda Angélica de Melo; Silva, Sônia Leite da

    2016-01-01

    Kidney transplants with expanded criteria donor have been associated with improved patient survival compared to those who remain on dialysis. To compare renal function and survival of the kidney graft of deceased donor with expanded criteria and standard criteria over a year in a single transplant center. 255 kidney transplant recipients with deceased donor were included in the study between the years 2011 to 2013 and they were separated into two groups according to the type of donor (expanded criteria donor - ECD - and standard criteria donor - SCD). 231 deceased donor transplants (90.6%) were performed with standard criteria donor (SCD) and 24 (9.4%) with expanded criteria donor (ECD). There was no difference in the prevalence of delayed graft function - DGF - (62.9% vs. 70.8%; p = 0.44). Expanded criteria donor group had lower glomerular filtration rate (GFR) at the end of the 1st year (56.8 ± 26.9 vs. 76.9 ± 23.7; p = 0.001). Patient survival was significantly lower in the ECD group, but the graft survival was not different after death-censored analysis. The ECD group was associated with significantly lower levels of GFR during the first year of transplant and a lower patient survival at the 1st year when compared to the SCD. A aceitação dos rins com critério expandido de doação tem sido associada com melhor sobrevida do paciente em comparação àqueles que permanecem em terapia dialítica. Comparar a função renal e a sobrevida do enxerto renal de doador falecido critério expandido com os de doador falecido critério padrão ao longo de um ano em um único centro de transplantes. Foram incluídos 255 receptores de transplante renal com doador falecido, realizados entre os anos de 2011 a 2013, sendo divididos em dois grupos segundo o tipo de doador (critério expandido - DCE - ou padrão -DCP). Foram avaliados 231 receptores com doador critério ideal (90,6%) e 24 com doador critério expandido (9,4%). Não houve diferença na prevalência de fun

  15. Dual Criteria Decisions

    DEFF Research Database (Denmark)

    Andersen, Steffen; Harrison, Glenn W.; Lau, Morten Igel

    2014-01-01

    The most popular models of decision making use a single criterion to evaluate projects or lotteries. However, decision makers may actually consider multiple criteria when evaluating projects. We consider a dual criteria model from psychology. This model integrates the familiar tradeoffs between...... to the clear role that income thresholds play in such decision making, but does not rule out a role for tradeoffs between risk and utility or probability weighting....

  16. The Potential Biochemical Diagnosis Criteria and Therapeutic Effect Indexes: Sex Hormone Binding Globulin Levels and Free Androgen Index in Blood of Patients With Polycystic Ovary Syndrome

    Science.gov (United States)

    2013-02-02

    The Investigators Collected 534 PCOS Patients as the Case Group,and 580 Infertile Women With Normal Ovulatory Cycle of the Control Group;; At the Same Time, the Investigators Continuedly Collect Cases to October 2012, and Totally Collected 579 Patients With PCOS Altogether;; 534 Patients in the Cases Group and 580 Women in the Control Group Received no Measures, While 579 Patients Received Drugs;; The Investigators Monitored Basic Indexes in Blood of All the Subjects in This Suvey,and Also Monitored Indexes of 579 Patients After Treatment.

  17. Rating of environmental criteria

    Energy Technology Data Exchange (ETDEWEB)

    Glueck, K; Krasser, G

    1980-01-01

    After a general theoretical discussion on the question of rating within a framework of cost-benefit studies, first trials as to the quantification and standardisation of twelve selected environmental criteria by means of an indicator system are worked out and compiled. The selection includes the criteria exhaust gas, dust, micro climate, water pollution, water regime, land requirement, vibrations, traffic noise, landscape scene, urban scene, effect of separation and safety risks. An insight is given of the rating practice using an evaluation of the available literature, of a household interview and of an interview of experts. The interviewing of 156 experts as to their rating conception of ten criteria in the second round has provided contributions to the general problem of the evaluation estimate based on multi criteria analysis as well as differentiation of the twelve or ten environmental criteria. The following criteria ratings given by the experts and which are averaged and smoothed are: traffic noise 20,0% +- 8,5; air pollution 15,0% +- 7,0; safety risk 13,0% +- 7,0; soil and water pollution 8,5% +- 5,0; landscape scene 8,0% +- 4,5; urban scene 8,0% +- 4,5; water regime 6,5% +- 3,5 and vibrations 4,5% +- 2,5.

  18. 10 CFR 1009.4 - Exclusions.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Exclusions. 1009.4 Section 1009.4 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) GENERAL POLICY FOR PRICING AND CHARGING FOR MATERIALS AND SERVICES SOLD BY DOE § 1009.4 Exclusions. This part shall not apply when the amount to be priced or charged is...

  19. Fighting poverty and exclusion through social investment

    DEFF Research Database (Denmark)

    Kvist, Jon

    The fight against poverty and social exclusion is at the heart of the Europe 2020 strategy for smart, sustainable and inclusive growth. With more than 120 million people in the EU at risk of poverty or social exclusion, EU leaders have pledged to bring at least 20 million people out of poverty an...

  20. 18 CFR 1308.3 - Exclusions.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Exclusions. 1308.3... General Matters § 1308.3 Exclusions. (a) This part does not apply to any TVA contract which does not contain a disputes clause. (b) Except as otherwise specifically provided, this part does not apply to any...

  1. Subspace exclusion zones for damage localization

    DEFF Research Database (Denmark)

    Bernal, Dionisio; Ulriksen, Martin Dalgaard

    2018-01-01

    , this is exploited in the context of structural damage localization to cast the Subspace Exclusion Zone (SEZ) scheme, which locates damage by reconstructing the captured field quantity shifts from analytical subspaces indexed by postulated boundaries, the so-called exclusion zones (EZs), in a model of the structure...

  2. The effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc lactate on the microflora of oral halitosis patients : a dual-centre, double-blind placebo-controlled study

    NARCIS (Netherlands)

    Roldan, S; Winkel, EG; Herrera, D; Sanz, M; Van Winkelhoff, AJ

    Aim: This study evaluated the microbial effects of a newly formulated mouthwash (Halita((R)) ) on oral halitosis patients. Methods: Forty subjects were included in this dual-centre, double-blind, placebo-controlled parallel study. Inclusion and exclusion criteria were used to select patients. At

  3. Lipid and lipoprotein responses of dyslipidemic patients to exclusive nutritional counseling by gender and age Resposta nos lípides e nas lipoproteínas séricas ao aconselhamento nutricional exclusivo em indivíduos dislipidêmicos segundo o sexo e a idade

    Directory of Open Access Journals (Sweden)

    Harumi Kinchoku

    2013-04-01

    Full Text Available OBJECTIVE: The aim of the present study was to evaluate the plasma lipid responses of dyslipidemic patients to nutritional counseling according to gender and age. METHODS: One-hundred and twenty nine dyslipidemic subjects comprised the study, 56 men and 73 women, aged 20 to 73 years, treated at the Dyslipidemia Outpatient Clinic of the Universidade Estadual de Campinas Clinic Hospital. The inclusion criteria established that no lipid-lowering medication had been used in the 30 days prior to and during the nutritional counseling. Blood samples were collected in the morning after a 12 hour fast. The participants were divided into groups according to gender and age (age 60 years. The hypercholesterolemic patients were instructed to restrict saturated fats (300mg/dL were asked to consume a low fat diet. Those with mixed hyperlipidemia were instructed to do both. Statistical analyses included the Wilcoxon, Mann-Whitney, Chi-square and Fisher's exact tests and Analysis of Covariance. RESULTS: After nutritional counseling, total cholesterol and triglycerides decreased by 16% and 36% in males, and by 12% and 26% in females, respectively, and Low Density Lipoprotein-cholesterol decreased by 12% in females. Only triglycerides decrease significantly. In the mixed hyperlipidemia group, the male and female triglyceride (-44% and -29%, Low Density Lipoprotein-cholesterol (+12% and -15% and High Density Lipoprotein-cholesterol (+7% and -3% levels differed significantly. Between the age groups, only triglyceride levels differed significantly, with adults experiencing the highest reductions (33%. CONCLUSION: Nutritional counseling effectively lowered plasma lipid and lipoprotein levels, reinforcing the benefits of dietary interventions for the treatment of dyslipidemia.OBJETIVO: Avaliar a resposta do perfil lipídico e das lipoproteínas plasmáticas ao aconselhamento nutricional em indivíduos dislipidêmicos analisando as respostas entre os sexos e as faixas

  4. Cirurgia redutora de volume pulmonar: critérios de seleção de pacientes no Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ Lung volume reduction surgery (LVRS: criteria for selecting patient in Antonio Pedro Hospital, Federal Fluminense University, Niterói city, Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Rodolfo Fred Behrsin

    2003-09-01

    mais de um fator mórbido a contra-indicar o seu procedimento. A maioria dos pacientes com critérios para CRVP, a recusa, com receio do procedimento ou após programas de reabilitação pulmonar. O critério mais significativo que indicou CRVP em um paciente operado foi a presença de enfisema heterogênio bilateral nos lobos superiores.BACKGROUND: Chronic Obstructive Pulmonary Disease (CPOD is an important problem in Brazil and other countries. The clinical treatment of ambulatory patients is now reasonably standardized. Lung volume reduction surgery (LVRS is an alternative of surgical treatment of emphysema (aside from lung transplantation. OBJECTIVES: The aim of this study was to analyse patient selection criteria for LVRS. METHODS: This study was carried out using a sample of 31 patients referred to and given assistance to at the Smoking and Chronic Obstructive Pulmonary Disease Outpatient Ward Antonio Pedro Hospital, who were evaluated to check whether or not they could be eligible for LVRS. Aiming at evaluating the major criteria for eligibility for LVRS, the patients underwent a protocol including standardized anamnesis and physical examination, spirometry with maximum inspiratory and expiratory flow volume curves associated with post-bronchodilatator test, room air arterial blood gases, a six-minute walking test, plain chest roentgenograms and left lateral chest roentgenograms, high-resolution chest computed tomographic scans and lung perfusion scans. Statistical analysis was conducted with description of data proportions. RESULTS: Contraindications to surgery included chronic bronchitis (29% or nine patients, forced expiratory volume in one second (FEV 1 more than 80 percent predicted (13% or four patients, negative consent for surgery (10% or three patients, fibrosis pattern, severe depression and bronchiectasis (two patients each one, solitary pulmonary nodule, severe obesity, severe bullous emphysema, pulmonary hipertension, pulmonary resection history

  5. Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome.

    Science.gov (United States)

    Harden, R Norman; Bruehl, Stephen; Perez, Roberto S G M; Birklein, Frank; Marinus, Johan; Maihofner, Christian; Lubenow, Timothy; Buvanendran, Asokumar; Mackey, Sean; Graciosa, Joseph; Mogilevski, Mila; Ramsden, Christopher; Chont, Melissa; Vatine, Jean-Jacques

    2010-08-01

    Current IASP diagnostic criteria for CRPS have low specificity, potentially leading to overdiagnosis. This validation study compared current IASP diagnostic criteria for CRPS to proposed new diagnostic criteria (the "Budapest Criteria") regarding diagnostic accuracy. Structured evaluations of CRPS-related signs and symptoms were conducted in 113 CRPS-I and 47 non-CRPS neuropathic pain patients. Discriminating between diagnostic groups based on presence of signs or symptoms meeting IASP criteria showed high diagnostic sensitivity (1.00), but poor specificity (0.41), replicating prior work. In comparison, the Budapest clinical criteria retained the exceptional sensitivity of the IASP criteria (0.99), but greatly improved upon the specificity (0.68). As designed, the Budapest research criteria resulted in the highest specificity (0.79), again replicating prior work. Analyses indicated that inclusion of four distinct CRPS components in the Budapest Criteria contributed to enhanced specificity. Overall, results corroborate the validity of the Budapest Criteria and suggest they improve upon existing IASP diagnostic criteria for CRPS. Copyright (c) 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  6. The representation of patient experience and satisfaction in physician rating sites. A criteria-based analysis of English- and German-language sites

    Directory of Open Access Journals (Sweden)

    Strech Daniel

    2010-12-01

    Full Text Available Abstract Background Information on patient experience and satisfaction with individual physicians could play an important role for performance measures, improved health care and health literacy. Physician rating sites (PRSs bear the potential to be a widely available source for this kind of information. However, patient experience and satisfaction are complex constructs operationalized by multiple dimensions. The way in which PRSs allow users to express and rate patient experience and satisfaction could likely influence the image of doctors in society and the self-understanding of both doctors and patients. This study examines the extent to which PRSs currently represent the constructs of patient experience and satisfaction. Methods First, a systematic review of research instruments for measuring patient experience and satisfaction was conducted. The content of these instruments was analyzed qualitatively to create a comprehensive set of dimensions for patient experience and patient satisfaction. Second, PRSs were searched for systematically in English-language and German-language search engines of Google and Yahoo. Finally, we classified every structured question asked by the different PRS using the set of dimensions of patient experience and satisfaction. Results The qualitative content analysis of the measurement instruments produced 13 dimensions of patient experience and satisfaction. We identified a total of 21 PRSs. No PRSs represented all 13 dimensions of patient satisfaction and experience with its structured questions. The 3 most trafficked English-language PRS represent between 5 and 6 dimensions and the 3 most trafficked German language PRSs between 8 and 11 dimensions The dimensions for patient experience and satisfaction most frequently represented in PRSs included diversely operationalized ones such as professional competence and doctor-patient relationship/support. However, other less complex but nevertheless important dimensions

  7. On the CT-diagnosis of optic nerve lesions. Differential diagnostic criteria

    International Nuclear Information System (INIS)

    Unsoeld, R.

    1982-01-01

    Computed tomograms of 166 optic nerve lesions were analyzed: 97 were mainly orbital and 69 mainly intracranial. The criteria were clinical course, size, density and delineation of the optic nerve shadow, orbital and cerebral soft tissue abnormalities, and bony changes in the optic canal. Characteristic CT features are described of individual disease entities such as optic gliomas, optic nerve sheath meningiomas, neoplastic and inflammatory infiltrations. The differential diagnostic importance of individual CT criteria is evaluated and discussed. Simultaneous visualization of orbital and intracranial soft tissue changes as well as bony changes in the optic canal allow the location and identification of the majority of optic nerve lesions based on the criteria mentioned above, and optic nerve tumors can be differentiated. In 9 patients with optic neuritis due to clinically proven encephalitis and in 17 patients with total optic atrophy, no changes in the size of the optic nerve could be found. CT evaluation of the intraorbital portion of the optic nerve requires special examination techniques. Oblique computer reformations through the optic canal provide excellent visualization of bony changes in the optic canal. The exclusion of intracranial causes of optic nerve lesions requires intravenous injection of contrast material. (orig.) [de

  8. 2016 Updates to US Medical Eligibility Criteria for Contraceptive Use and Selected Practice Recommendations for Contraceptive Use: Highlights for Adolescent Patients.

    Science.gov (United States)

    Hoopes, Andrea J; Simmons, Katharine B; Godfrey, Emily M; Sucato, Gina S

    2017-04-01

    The US Medical Eligibility Criteria for Contraceptive Use (MEC) and US Selected Practice Recommendations for Contraceptive Use (SPR) provide evidence-based guidance to safely provide contraception counseling and services. Both documents were updated in 2016 and are endorsed by the North American Society for Pediatric and Adolescent Gynecology. The purpose of this mini-review is to highlight updates to the US MEC and US SPR that are most relevant to health care providers of adolescents to support dissemination and implementation of these evidence-based best practices. This document is intended to highlight these changes and to complement, not replace, the detailed practice guidance within the US MEC and US SPR. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  9. Summarized water quality criteria

    International Nuclear Information System (INIS)

    Kempster, P.L.; Hattingh, W.H.J.; Van Vliet, H.R.

    1980-08-01

    The available world literature from 27 sources on existing water quality criteria are summarized for the 15 main uses of water. The minimum, median and maximum specified values for 96 different determinands are included. Under each water use the criteria are grouped according to the functional significance of the determinands e.g. aesthetic/physical effects, high toxic potential, low toxic potential etc. A synopsis is included summarizing salient facts for each determinand such as the conditions under which it is toxic and its relationship to other determinands. The significance of the criteria is briefly discussed and the importance of considering functional interactions between determinands emphasized in evaluating the potential for toxic or beneficial effects. From the source literature it appears that the toxic potential, in addition to being determined by concentration, is also affected by the origin of the substance concerned, i.e. whether from natural sources or from anthropogenic pollution

  10. Theta signal as the neural signature of social exclusion.

    Science.gov (United States)

    Cristofori, Irene; Moretti, Laura; Harquel, Sylvain; Posada, Andres; Deiana, Gianluca; Isnard, Jean; Mauguière, François; Sirigu, Angela

    2013-10-01

    The feeling of being excluded from a social interaction triggers social pain, a sensation as intense as actual physical pain. Little is known about the neurophysiological underpinnings of social pain. We addressed this issue using intracranial electroencephalography in 15 patients performing a ball game where inclusion and exclusion blocks were alternated. Time-frequency analyses showed an increase in power of theta-band oscillations during exclusion in the anterior insula (AI) and posterior insula, the subgenual anterior cingulate cortex (sACC), and the fusiform "face area" (FFA). Interestingly, the AI showed an initial fast response to exclusion but the signal rapidly faded out. Activity in the sACC gradually increased and remained significant thereafter. This suggests that the AI may signal social pain by detecting emotional distress caused by the exclusion, whereas the sACC may be linked to the learning aspects of social pain. Theta activity in the FFA was time-locked to the observation of a player poised to exclude the participant, suggesting that the FFA encodes the social value of faces. Taken together, our findings suggest that theta activity represents the neural signature of social pain. The time course of this signal varies across regions important for processing emotional features linked to social information.

  11. Blunt oesophageal perforation: treatment with surgical exclusion and percutaneous drainage under computed tomographic guidance

    International Nuclear Information System (INIS)

    Vauthey, J.N.; Lerut, J.; Laube, M.; Gertsch, P.

    1992-01-01

    We report a patient with a left thoracic contusion and rupture of the distal oesophagus. Persistent sepsis developed after oesophageal exclusion without closure. Two collection were drained percutaneously under computed tomographic guidance and the sepsis resolved. (11 refs., 1 fig.)

  12. Recognition and treatment of outflow tract stenosis during and after endovascular exclusion for abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Lu Qingsheng; Jing Zaiping; Zhao Zhiqing; Bao Junmin; Zhao Jun; Feng Xiang; Feng Rui; Huang Sheng

    2003-01-01

    Objective: To study the cognition and treatment of outflow tract stenosis in and after endovascular exclusion for abdominal aortic aneurysm. Methods: From Mar 1997 to Oct 2002, in 136 patients undergoing abdominal aortic aneurysm endovascular exclusion, 8 patients had outflow tract stenosis during the operation, and 3 patients had outflow tract stenosis after operation. The stenosis of 5 patients occurred at the crotch of the graft-stent. PTA was done in 7 patients and stents were placed in stenotic segment in 2 patients. 2 patients were treated with crossover operation. Results: Following up 1 month to 2 years, all patients have no lower limbs ischemia. Conclusions: The diagnosis of outflow tract stenosis during and after abdominal endovascular exclusion for aortic aneurysm must be in time. The treatment should be according to the different causes of stenosis

  13. Exclusion as a Criterion for Selecting Socially Vulnerable Population Groups

    Directory of Open Access Journals (Sweden)

    Aleksandra Anatol’evna Shabunova

    2016-05-01

    Full Text Available The article considers theoretical aspects of a scientific research “The Mechanisms for Overcoming Mental Barriers of Inclusion of Socially Vulnerable Categories of the Population for the Purpose of Intensifying Modernization in the Regional Community” (RSF grant No. 16-18-00078. The authors analyze the essence of the category of “socially vulnerable groups” from the legal, economic and sociological perspectives. The paper shows that the economic approach that uses the criterion “the level of income and accumulated assets” when defining vulnerable population groups prevails in public administration practice. The legal field of the category based on the economic approach is defined by the concept of “the poor and socially unprotected categories of citizens”. With the help of the analysis of theoretical and methodological aspects of this issue, the authors show that these criteria are a necessary but not sufficient condition for classifying the population as being socially vulnerable. Foreign literature associates the phenomenon of vulnerability with the concept of risks, with the possibility of households responding to them and with the likelihood of losing the well-being (poverty theory; research areas related to the means of subsistence, etc.. The asset-based approaches relate vulnerability to the poverty that arises due to lack of access to tangible and intangible assets. Sociological theories presented by the concept of social exclusion pay much attention to the breakdown of social ties as a source of vulnerability. The essence of social exclusion consists in the inability of people to participate in important aspects of social life (in politics, labor markets, education and healthcare, cultural life, etc. though they have all the rights to do so. The difference between the concepts of exclusion and poverty is manifested in the displacement of emphasis from income inequality to limited access to rights. Social exclusion is

  14. Functional vision loss: a diagnosis of exclusion.

    Science.gov (United States)

    Villegas, Rex B; Ilsen, Pauline F

    2007-10-01

    Most cases of visual acuity or visual field loss can be attributed to ocular pathology or ocular manifestations of systemic pathology. They can also occasionally be attributed to nonpathologic processes or malingering. Functional vision loss is any decrease in vision the origin of which cannot be attributed to a pathologic or structural abnormality. Two cases of functional vision loss are described. In the first, a 58-year-old man presented for a baseline eye examination for enrollment in a vision rehabilitation program. He reported bilateral blindness since a motor vehicle accident with head trauma 4 years prior. Entering visual acuity was "no light perception" in each eye. Ocular health examination was normal and the patient made frequent eye contact with the examiners. He was referred for neuroimaging and electrophysiologic testing. The second case was a 49-year-old man who presented with a long history of intermittent monocular diplopia. His medical history was significant for psycho-medical evaluations and a diagnosis of factitious disorder. Entering uncorrected visual acuities were 20/20 in each eye, but visual field testing found constriction. No abnormalities were found that could account for the monocular diplopia or visual field deficit. A diagnosis of functional vision loss secondary to factitious disorder was made. Functional vision loss is a diagnosis of exclusion. In the event of reduced vision in the context of a normal ocular health examination, all other pathology must be ruled out before making the diagnosis of functional vision loss. Evaluation must include auxiliary ophthalmologic testing, neuroimaging of the visual pathway, review of the medical history and lifestyle, and psychiatric evaluation. Comanagement with a psychiatrist is essential for patients with functional vision loss.

  15. Rethinking Intelligence Quotient Exclusion Criteria Practices in the Study of Attention Deficit Hyperactivity Disorder

    Directory of Open Access Journals (Sweden)

    Genevieve Brooke Mackenzie

    2016-05-01

    Full Text Available Attention Deficit Hyperactivity Disorder (ADHD is associated with lower than average intelligence quotient (IQ scores. However, research done on this disorder often excludes participants based on lower than average IQ’s (i.e. between 70 and 85. The purpose of this paper is to alert researchers to the consequences of excluding participants based on IQ’s within this range and to highlight the importance of providing a clear rationale when choosing to exclude participants based on IQ. Next, we offer recommendations for researching ADHD and their relative benefits and drawbacks of these approaches. Overall this paper emphasizes that including participants who have lower than average IQ in research on ADHD may promote a more realistic understanding of the condition and in turn improve our ability to treat it.

  16. Rethinking Intelligence Quotient Exclusion Criteria Practices in the Study of Attention Deficit Hyperactivity Disorder

    Science.gov (United States)

    Mackenzie, Genevieve B.; Wonders, Elif

    2016-01-01

    Attention deficit hyperactivity disorder (ADHD) is associated with lower than average intelligence quotient (IQ) scores. However, research done on this disorder often excludes participants based on lower than average IQ’s (i.e., between 70 and 85). The purpose of this paper is to alert researchers to the consequences of excluding participants based on IQ’s within this range and to highlight the importance of providing a clear rationale when choosing to exclude participants based on IQ. Next, we offer recommendations for researching ADHD and their relative benefits and drawbacks of these approaches. Overall this paper emphasizes that including participants who have lower than average IQ in research on ADHD may promote a more realistic understanding of the condition and in turn improve our ability to treat it. PMID:27303350

  17. Radiological design criteria

    International Nuclear Information System (INIS)

    Selby, J.M.; Andersen, B.V.; Carter, L.A.; Waite, D.A.

    1977-01-01

    Many new nuclear facilities are unsatisfactory from a radiation protection point of view, particularly when striving to maintain occupational exposure as low as practicable 'ALAP'. Radiation protection is achieved through physical protective features supplemented by administrative controls. Adequate physical protective feature should be achieved during construction so that supplemental administrative controls may be kept simple and workable. Many nuclear facilities fall short of adequate physical protective features, thus, remedial and sometimes awkward administrative procedures are required to safely conduct work. In reviewing the various handbooks, reports and regulations which deal with radiation protection, it may be noted that there is minimal radiological design guidance for application to nuclear facilities. A set of criteria or codes covering functional areas rather than specific nuclear facility types is badly needed. The following are suggested as functional areas to be considered: characterization of the Facility; siting and access; design exposure limits; layout (people and materials flow); ventilation and effluent control; radiation protection facilities and systems. The application of such radiological design criteria early in the design process would provide some assurance that nuclear facilities will be safe, flexible, and efficient with a minimum of costly retrofitting or administrative restrictions. Criteria which we have found helpful in these functional areas is discussed together with justification for adoption of such criteria and identification of problems which still require solution

  18. Comments on confinement criteria

    International Nuclear Information System (INIS)

    Kurak, V.; Schroer, B.; Swieca, J.A.

    1977-01-01

    For a QED 2 model with SU(n) flavour, the nature of the physical states space is more subtle than one expects on the basis of the loop criterion for confinement. One may have colour confinement without confinement of the fundamental flavour representation. Attempts to formulate confinement criteria in which the quark fields play a more fundamental role are discussed [pt

  19. Osteoblastic flare in a patient with advanced gastric cancer after treatment with pemetrexed and oxaliplatin: implications for response assessment with RECIST criteria

    Directory of Open Access Journals (Sweden)

    Simoncini Edda

    2007-06-01

    Full Text Available Abstract Background The RECIST guidelines are commonly used in phase II and III clinical trials. The correct definition of response can be controversial in some situations, as in the case we describe. Case presentation A 43 year-old man with advanced gastric cancer was enrolled in a phase II trial where he was treated with pemetrexed 500 mg/m2 plus oxaliplatin 120 mg/m2 every 3 weeks. At baseline, the target lesions were lymph-nodes, and the non-target lesions were small pulmonary nodules. At first re-evaluation, the target lesions showed partial response and the non-target lesions showed complete response, but new diffuse osteoblastic lesions appeared. The investigator decided to continue treatment until the second re-evaluation. CT scan confirmed the response of the target and non-target lesions, while the osteoblastic lesions did not change. Conclusion The appearance of osteoblastic lesions after an active antitumor treatment, a phenomenon known as flare, can complicate the definition of the best overall response using RECIST criteria. This possibility should be considered by oncologists involved in clinical trials.

  20. Robust Visual Tracking via Exclusive Context Modeling

    KAUST Repository

    Zhang, Tianzhu; Ghanem, Bernard; Liu, Si; Xu, Changsheng; Ahuja, Narendra

    2015-01-01

    appearances as linear combinations of dictionary templates that are updated dynamically. Learning the representation of each particle is formulated as an exclusive sparse representation problem, where the overall dictionary is composed of multiple {group

  1. Exclusive hadronic processes and color transparency

    Indian Academy of Sciences (India)

    It is known that at asymptotically large momentum transfer certain exclusive hadronic ... indicates that the Brodsky–Lepage factorization scheme fails, independent of ..... A basic feature of *-initiated reactions is that most events are knocked out.

  2. Exclusion, exemption, clearance European Union approach

    International Nuclear Information System (INIS)

    Janssens, A.

    1997-01-01

    The presentation overviews the following issues: Euratom Basic Safety Standards; administrative requirements; radiation protection of the population. Scope of the Standards: natural radiation sources; exclusion. Exemption; Clearance; Import of radioactive scrap metal

  3. Imaging partons in exclusive scattering processes

    Energy Technology Data Exchange (ETDEWEB)

    Diehl, Markus

    2012-06-15

    The spatial distribution of partons in the proton can be probed in suitable exclusive scattering processes. I report on recent performance estimates for parton imaging at a proposed Electron-Ion Collider.

  4. Nonlinear Cross-Diffusion with Size Exclusion

    KAUST Repository

    Burger, Martin; Di Francesco, Marco; Pietschmann, Jan-Frederik; Schlake, Bä rbel

    2010-01-01

    The aim of this paper is to investigate the mathematical properties of a continuum model for diffusion of multiple species incorporating size exclusion effects. The system for two species leads to nonlinear cross-diffusion terms with double

  5. Definition of Exclusion Zones Using Seismic Data

    Science.gov (United States)

    Bartal, Y.; Villagran, M.; Ben Horin, Y.; Leonard, G.; Joswig, M.

    - In verifying compliance with the Comprehensive Nuclear-Test-Ban Treaty (CTBT), there is a motivation to be effective, efficient and economical and to prevent abuse of the right to conduct an On-site Inspection (OSI) in the territory of a challenged State Party. In particular, it is in the interest of a State Party to avoid irrelevant search in specific areas. In this study we propose several techniques to determine `exclusion zones', which are defined as areas where an event could not have possibly occurred. All techniques are based on simple ideas of arrival time differences between seismic stations and thus are less prone to modeling errors compared to standard event location methods. The techniques proposed are: angular sector exclusion based on a tripartite micro array, half-space exclusion based on a station pair, and closed area exclusion based on circumferential networks.

  6. Exclusion, Violence, and Community Responses in Central ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Personal

    2015-05-13

    May 13, 2015 ... similar conditions of social exclusion, different levels of violence can be explained because communities capacities to face violence. • Methodology: ... in El Salvador. • Mix of quantitative and qualitative techniques of research.

  7. Exclusive processes at high momentum transfer

    CERN Document Server

    Radyushkin, Anatoly; Stoker, Paul

    2002-01-01

    This book focuses on the physics of exclusive processes at high momentum transfer and their description in terms of generalized parton distributions, perturbative QCD, and relativistic quark models. It covers recent developments in the field, both theoretical and experimental.

  8. The HAQ compared with the MDHAQ: "keep it simple, stupid" (KISS), with feasibility and clinical value as primary criteria for patient questionnaires in usual clinical care.

    Science.gov (United States)

    Pincus, Theodore; Swearingen, Christopher J

    2009-11-01

    The health assessment questionnaire (HAQ) is the questionnaire most widely used to assess and monitor patients with rheumatic diseases. The HAQ includes 20 activities grouped into 8 categories of 2 or 3 (and queries the use of "aids and devices" and "help from another person" to perform these activities), and visual analog scales (VAS) for pain and patient global estimate of status. Use of the HAQ in usual care over the years has led to several modifications to develop a multidimensional HAQ (MDHAQ). The MDHAQ includes 10 activities, one from each category of the HAQ plus 2 complex activities-walk 2 miles or 3 km-all on one side of a page for easy "eyeball" review by a clinician; pain, global and fatigue VAS with 21 circles rather than 10-cm lines for ease of scoring; recent medical history; review of systems; a query about exercise; and scoring templates for the 3 rheumatoid arthritis (RA) Core Data Set patient-reported measures-physical function, pain, and global estimate-for a routine assessment of patient index data (RAPID3) composite score. Both the HAQ and MDHAQ involve 2 sides of one sheet of paper, and are completed by patients in 5 to 10 minutes. The HAQ requires 42 seconds to score, compared with 5 to 10 seconds for RAPID3 on the MDHAQ.

  9. Immersive virtual reality improves movement patterns in patients after ACL reconstruction: implications for enhanced criteria-based return-to-sport rehabilitation.

    Science.gov (United States)

    Gokeler, Alli; Bisschop, Marsha; Myer, Gregory D; Benjaminse, Anne; Dijkstra, Pieter U; van Keeken, Helco G; van Raay, Jos J A M; Burgerhof, Johannes G M; Otten, Egbert

    2016-07-01

    The purpose of this study was to evaluate the influence of immersion in a virtual reality environment on knee biomechanics in patients after ACL reconstruction (ACLR). It was hypothesized that virtual reality techniques aimed to change attentional focus would influence altered knee flexion angle, knee extension moment and peak vertical ground reaction force (vGRF) in patients following ACLR. Twenty athletes following ACLR and 20 healthy controls (CTRL) performed a step-down task in both a non-virtual reality environment and a virtual reality environment displaying a pedestrian traffic scene. A motion analysis system and force plates were used to measure kinematics and kinetics during a step-down task to analyse each single-leg landing. A significant main effect was found for environment for knee flexion excursion (P = n.s.). Significant interaction differences were found between environment and groups for vGRF (P = 0.004), knee moment (P virtual reality environment on knee biomechanics in patients after ACLR compared with controls. Patients after ACLR immersed in virtual reality environment demonstrated knee joint biomechanics that approximate those of CTRL. The results of this study indicate that a realistic virtual reality scenario may distract patients after ACLR from conscious motor control. Application of clinically available technology may aid in current rehabilitation programmes to target altered movement patterns after ACLR. Diagnostic study, Level III.

  10. El diseño de criterios de manejo del paciente diabético como estrategia de garantía de calidad Designing criteria to handle diabetes patients as a strategy for quality assurance

    Directory of Open Access Journals (Sweden)

    Armando Martínez Ramírez

    1996-12-01

    Full Text Available El presente estudio se realizó en el Hospital General de Zona nº 14 en Jalisco, México, con el objetivo de diseñar criterios estandarizados de manejo del paciente diabético en los servicios de hospitalización, como una estrategia de garantía de calidad, a través de la participación de un panel de expertos del servicio de medicina interna del propio hospital. La participación del médico responsable del proceso de la atención médica en el diseño de los criterios genera en el personal un sentido de pertenencia y facilita su adherencia y aplicación. Ciertamente, los criterios sugeridos son perfectibles y de ninguna manera se pretende su aplicación universal, si de alguna manera resultan útiles para quienes atienden estos pacientes, rebasaría con mucho los objetivos que los autores se plantearon en la planeación de la investigación.This study was carried out at the General Hospital of Zone Nº 14 of the IMSS in Jalisco, Mexico, with the goal of designing standardized criteria to handle hospitalized diabetes patients, as a strategy for quality assurance, through the participation of a panel of experts in internal medicine from the hospital. Participation by the attending physician in designing criteria generates a sense of belonging in the staff and makes adherence and application easier. The suggested criteria are subject to further improvement and are not intended for universal application, but to the extent that they have been useful in patient care they have far surpassed the authors' expectations when the goals of this research were originally established.

  11. Exclusive endoscopic resection of juvenile nasopharyngeal angiofibroma: a systematic review of the literature.

    Science.gov (United States)

    Khoueir, Nadim; Nicolas, Nicolas; Rohayem, Ziad; Haddad, Amine; Abou Hamad, Walid

    2014-03-01

    To systematically review the exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma in the literature to define the clinical features in terms of staging and the treatment outcomes in terms of bleeding, recurrence, residual tumor, and complications. Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles. The literature was searched by 2 reviewers with the following inclusion criteria: English or French language and exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma. We were only able to perform a meta-analysis on the categorical outcomes using DerSimonian and Laird random effects models. Ninety-two studies were included with a majority of retrospective studies (54/92; 58.6%). No randomized controlled trials were found. A total of 821 patients were identified. The Radowski classification was the most commonly used (29/92; 31.15%). The mean operative blood loss was 564.21 mL (minimum, 20 mL; maximum, 1482 mL). It was 414.6 mL (minimum, 20 mL; maximum, 1000 mL) and 774.2 mL (minimum, 228 mL; maximum, 1482 mL), respectively, in the group with and without embolization. No conclusion could be made because it was not stratified by tumor stage and because of the absence of randomized controlled trials. The random effect estimate of recurrence was 10% (95% confidence interval [CI], 8.3-11.7). It was 9.3% (95% CI, 7.2-11.5) for complications and 7.7% (95% CI, 5.4-10.1) for residual tumor. The endoscopic treatment is an evolving modality. It is considered today the treatment of choice. A new classification system based on the endoscopic approach should be proposed in future studies.

  12. Model of reversible vesicular transport with exclusion

    International Nuclear Information System (INIS)

    Bressloff, Paul C; Karamched, Bhargav R

    2016-01-01

    A major question in neurobiology concerns the mechanics behind the motor-driven transport and delivery of vesicles to synaptic targets along the axon of a neuron. Experimental evidence suggests that the distribution of vesicles along the axon is relatively uniform and that vesicular delivery to synapses is reversible. A recent modeling study has made explicit the crucial role that reversibility in vesicular delivery to synapses plays in achieving uniformity in vesicle distribution, so called synaptic democracy (Bressloff et al 2015 Phys. Rev. Lett. 114 168101). In this paper we generalize the previous model by accounting for exclusion effects (hard-core repulsion) that may occur between molecular motor-cargo complexes (particles) moving along the same microtubule track. The resulting model takes the form of an exclusion process with four internal states, which distinguish between motile and stationary particles, and whether or not a particle is carrying vesicles. By applying a mean field approximation and an adiabatic approximation we reduce the system of ODEs describing the evolution of occupation numbers of the sites on a 1D lattice to a system of hydrodynamic equations in the continuum limit. We find that reversibility in vesicular delivery allows for synaptic democracy even in the presence of exclusion effects, although exclusion does exacerbate nonuniform distributions of vesicles in an axon when compared with a model without exclusion. We also uncover the relationship between our model and other models of exclusion processes with internal states. (paper)

  13. Association between Exclusive Breastfeeding and Child Development

    Directory of Open Access Journals (Sweden)

    Ghaniyyatul Khudri

    2016-03-01

    Full Text Available Background: Child development highly correlates with child’s quality. The fastest child development period is during the first three years, also called golden period. This research was aimed to discover correlation between exclussive breastfeeding and child development in Cipacing Village Jatinangor, district of Sumedang. Methods: This research was conducted using cross-sectional method in thirteen Pos Pelayanan Terpadu (Posyandu Cipacing Village in Jatinangor. One hundred and two children aged 12−24 months with their caregiver were recruited as respondents by using cluster sampling method. Hist ory of exclusive breastfeeding was assessed with questionnaire while child development status was assesed with Kuesioner Pra Skrining Perkembangan (KPSP in September 2013 after informed consent was obtained. Chi-square test analysis was performed to determine correlation between exclusive breastfeeding and child development status. Results: Overall, children in Cipacing Village had non-exclusive breastfeeding history (83.3%, and only 16.7% respondents had exclusive breastfeeding history. Meanwhile, 89.2% of children had normal development status, and 10.8% had delayed development status. Statistic analysis using chi-square test in the level of 95% confidence between exclusive breastfeeding and child development showed p=0.686 and odds ratio 2.133. Conclusions: There is no significant relationship between history of exclusive breastfeeding and child development status.

  14. Patent and exclusivity status of essential medicines for non-communicable disease.

    Directory of Open Access Journals (Sweden)

    Tim K Mackey

    Full Text Available OBJECTIVE: The threat of non-communicable diseases ("NCDs" is increasingly becoming a global health crisis and are pervasive in high, middle, and low-income populations resulting in an estimated 36 million deaths per year. There is a need to assess intellectual property rights ("IPRs" that may impede generic production and availability and affordability to essential NCD medicines. METHODS: Using the data sources listed below, the study design systematically eliminated NCD drugs that had no patent/exclusivity provisions on API, dosage, or administration route. The first step identified essential medicines that treat certain high disease burden NCDs. A second step examined the patent and exclusivity status of active ingredient, dosage and listed route of administration using exclusion criteria outlined in this study. MATERIALS: We examined the patent and exclusivity status of medicines listed in the World Health Organization's ("WHO" Model List of Essential Drugs (Medicines ("MLEM" and other WHO sources for drugs treating certain NCDs. i.e., cardiovascular and respiratory disease, cancers, and diabetes. We utilized the USA Food and Drug Administration Orange Book and the USA Patent and Trademark Office databases as references given the predominant number of medicines registered in the USA. RESULTS: Of the 359 MLEM medicines identified, 22% (79/359 address targeted NCDs. Of these 79, only eight required in-depth patent or exclusivity assessment. Upon further review, no NCD MLEM medicines had study patent or exclusivity protection for reviewed criteria. CONCLUSIONS: We find that ensuring availability and affordability of potential generic formulations of NCD MLEM medicines appears to be more complex than the presence of IPRs with API, dosage, or administration patent or exclusivity protection. Hence, more sophisticated analysis of NCD barriers to generic availability and affordability should be conducted in order to ensure equitable access to global

  15. Does clinical remission lead to normalization of EQ-5D in patients with rheumatoid arthritis and is selection of remission criteria important?

    DEFF Research Database (Denmark)

    Linde, Louise; Sørensen, Jan; Østergaard, Mikkel

    2010-01-01

    patient as the difference from the age and sex-matched general population and adjusted for age, marital status, education, body mass index, smoking, exercise habits, disease duration, IgM-rheumatoid factor status, joint surgery, extraarticular features, treatment, and comorbidity in multiple linear...

  16. Stability of clinical outcome measures in rheumatoid arthritis patients with stable disease defined on the basis of the EULAR response criteria

    DEFF Research Database (Denmark)

    Madsen, Ole Rintek

    2016-01-01

    patient. Using the Bland-Altman method, lower and upper 95 % limits of agreement (LLoA; ULoA) between the consecutive assessments and the bias were calculated for each measure. Associations were characterized by Pearson's r-values and standard errors of estimation (SEE). The mean change in DAS28-CRP was 0...

  17. MDS classification is improving in an era of the WHO 2016 criteria of MDS: A population-based analysis among 9159 MDS patients diagnosed in the Netherlands.

    Science.gov (United States)

    Dinmohamed, Avinash G; Visser, Otto; Posthuma, Eduardus F M; Huijgens, Peter C; Sonneveld, Pieter; van de Loosdrecht, Arjan A; Jongen-Lavrencic, Mojca

    2017-10-01

    Morphologic and cytogenetic assessments are required to characterize diagnostic and prognostic features of myelodysplastic syndromes (MDS). We assessed whether these assessments were performed among newly diagnosed MDS patients in the Netherlands. MDS cases were retrieved from the nationwide Netherlands Cancer Registry (N=9159; period 2001-2014) and the regional PHAROS MDS registry (N=676; period 2008-2011). The proportion of unclassified MDS decreased from 58% in 2001 to 13% in 2014. Data from the more detailed PHAROS registry revealed that the degree of bone marrow dysplasia was only reported in ∼30% of all evaluable bone marrow aspirates. Further, the International Prognostic Scoring System was undetermined in 55% of patients, primarily owing to unperformed cytogenetics in 46% of patients. The classification of MDS is improving in the Netherlands. Nevertheless, particular diagnostic and prognostic procedures that are essential for the diagnosis and subsequent treatment decision-making of MDS were not fully utilized in particular patient subsets. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Effect of Keishibukuryogan on Endothelial Function in Patients with at Least One Component of the Diagnostic Criteria for Metabolic Syndrome: A Controlled Clinical Trial with Crossover Design

    Directory of Open Access Journals (Sweden)

    Yutaka Nagata

    2012-01-01

    Full Text Available We evaluated the effect of keishibukuryogan (KBG; Guizhi-Fuling-Wan, a traditional Japanese (Kampo formula, on endothelial function assessed by reactive hyperemia peripheral arterial tonometry (Endo-PAT2000 in patients with metabolic syndrome-related factors by controlled clinical trial with crossover design. Ninety-two patients were assigned to group A (first KBG-treatment period, then control period; each lasting 4 weeks, with about one-year interval or group B (first control, then KBG-treatment. In forty-nine (27, group A; 22, group B patients completing all tests, the mean value of the natural logarithmic-scaled reactive hyperemia index (L_RHI increased and those of serum nonesterified fatty acid (NEFA, malondialdehyde, and soluble vascular cell adhesion molecule 1 decreased significantly during the KBG-treatment period, but not during the control period, and 4-week changes of L_RHI, NEFA, and malondialdehyde between the 2 periods showed significance. These results suggest that KBG has beneficial effect on endothelial function in patients with metabolic syndrome-related factors.

  19. Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria

    NARCIS (Netherlands)

    Koeze, J.; Keus, F.; Dieperink, W.; van der Horst, I. C. C.; Zijlstra, J. G.; van Meurs, M.

    2017-01-01

    Background: Acute kidney injury (AKI) is a serious complication of critical illness with both attributed morbidity and mortality at short-term and long-term. The incidence of AKI reported in critically ill patients varies substantially with the population evaluated and the definitions used. We aimed

  20. Pan-enteric dysmotility, impaired quality of life and alexithymia in a large group of patients meeting ROME II criteria for irritable bowel syndrome

    OpenAIRE

    Portincasa, Piero; Moschetta, Antonio; Baldassarre, Giuseppe; Altomare, Donato F.; Palasciano, Giuseppe

    2003-01-01

    AIM: Psychological factors, altered motility and sensation disorders of the intestine can be variably associated with irritable bowel syndrome (IBS). Such aspects have not been investigated simultaneously. The aim of this paper was to evaluate gastrointestinal motility and symptoms, psychological spectrum and quality of life in a large group of IBS patients in southern Italy.

  1. [Drug addiction and social exclusion].

    Science.gov (United States)

    Solal, J F; Schneider, M C

    1996-10-01

    Destitute drug addicts have not deliberately chosen to be socially excluded; it's more the consequence of a sanitary and social policy which has given a greater importance to the treatment of addiction than to the drug addict's health. Facing Aids, physicians, with their pragmatic attitude, have reversed this drift. On the streets, the drug addict holds handicaps concurrently; medicinal addiction leads to harder sevrance and substitution. Having access to social rights allows to regain an identity, compulsory for an access to health care; but public hospitals have to make casier both the admission and the stay of patients whose therapeutic observance is dependent on a preliminary substitution. Drug addiction and precarity represent a double social challenge that a democratic society must take up without any segregation.

  2. MDS clinical diagnostic criteria for Parkinson's disease in China.

    Science.gov (United States)

    Li, Jun; Jin, Miao; Wang, Li; Qin, Bin; Wang, Kang

    2017-03-01

    The Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's disease (MDS-PD Criteria) was introduced by the Movement Disorder Society in 2015 for research purposes. However, its use for clinical diagnosis of Parkinson disease still needs further revision. This study compares the UK-Criteria versus MDS-PD Criteria in the clinical diagnosis of Parkinson disease referred to the China-Japan Friendship Hospital of Beijing, China. To compare the MDS-PD Criteria with the UK-Criteria and discuss the feasibility of the clinical application of MDS-PD Criteria as a general guide to clinical diagnosis of PD in Chinese PD patients. 150 patients of neurology clinic of China-Japan Friendship Hospital of Beijing were recruited in our research. They were divided into three groups: UK-Criteria group, MDS-PD Criteria group and a combined group of UK and MDS-PD Criteria. Clinical history was collected while physical and auxiliary examinations were done by a trained neurologist according to the corresponding criteria. An interrater reliability analysis using the Kappa statistic claimed substantial agreement (κ = 0.626) between the MDS-PD Criteria and the UK-Criteria. The differences between the diagnostic results of these two criteria were statistically significant by paired Chi-square test (p = 0.000). It was found that levodopa-induced dyskinesia had a good positive predictive value, while early bulbar impairment and inspiratory dysfunction presented a negative predictive value. The MDS-PD Criteria emphasize the importance of non-motor symptoms, keeping the motor symptoms as the core for the clinical diagnosis of PD, and establish categories of diagnosis features and levels of certainty which are more complete and organized to be used and replicated by non specialized physicians to evaluated patients with Parkinsonism. The higher sensitivity of MDS-PD Criteria compared with UK-Criteria is worth being widely used in clinical work.

  3. Improving Exclusive Breastfeeding in an Urban Academic Hospital.

    Science.gov (United States)

    Ward, Laura P; Williamson, Susan; Burke, Stephanie; Crawford-Hemphill, Ruby; Thompson, Amy M

    2017-02-01

    Breastfeeding has many well-established health benefits for infants and mothers. There is greater risk reduction in health outcomes with exclusive breastfeeding (EBF). Our urban academic facility has had long-standing low EBF rates, serving a population with breastfeeding disparities. We sought to improve EBF rates through a Learning Collaborative model by participating in the Best Fed Beginnings project. Formal improvement science methods were used, including the development of a key driver diagram and plan-do-study-act cycles. Improvement activities followed the Ten Steps to Successful Breastfeeding. We demonstrated significant improvement in the median adherence to 2 process measures, rooming in and skin-to-skin after delivery. Subsequently, the proportion of infants exclusively breastfed at hospital discharge in our facility increased from 37% to 59%. We demonstrated an increase in sustained breastfeeding in a subset of patients at a postpartum follow-up visit. These improvements led to Baby-Friendly designation at our facility. This quality improvement initiative resulted in a higher number of infants exclusively breastfed in our patient population at "high risk not to breastfeed." Other hospitals can use these described methods and techniques to improve their EBF rates. Copyright © 2017 by the American Academy of Pediatrics.

  4. Exclusive contracts in the hospital setting: a two-edged sword, part 1: legal issues.

    Science.gov (United States)

    Portman, Robert M

    2007-05-01

    Hospitals routinely enter into contracts with radiology groups for the right to be the exclusive provider of radiology services at the facility in exchange for the group agreeing to provide and manage all aspects of that service within the hospital. These "exclusive contracts" generally result in the radiology department and associated equipment being closed off to physicians who are not part of the contracting group. Exclusive contracts are generally considered to be good for physicians who have them and bad for those excluded by them. In fact, while exclusive contracts offer obvious benefits to the physicians who receive them and obvious disadvantages for those who are excluded, they also present pitfalls for physicians in the chosen group. Part I of this article discusses the legal issues raised by exclusive contracts. Although these agreements appear to be anti-competitive, most courts have rejected antitrust challenges to exclusive contracts. Excluded physicians have had much greater success in attacking exclusive contracting arrangements on breach of contract and procedural/due process grounds. Exclusive contracting arrangements can also raise concerns under the Medicare-Medicaid anti-kickback statute if the contracting physicians are required to pay consideration or accept less than fair market value compensation in exchange for exclusive contracts. These agreements can also raise issues under the Stark II physician self-referral law if the contracting physicians are in a position to refer Medicare or Medicaid patients to the hospital. Part II of this article will discuss the advantages and disadvantages of exclusive contracts for physicians covered and not covered by such contracts, as well as strategies for avoiding them or minimizing their potential adverse impact. It also will discuss specific provisions of exclusive contracts that should be included or avoided.

  5. Human Systems Design Criteria

    DEFF Research Database (Denmark)

    Rasmussen, Jens

    1982-01-01

    This paper deals with the problem of designing more humanised computer systems. This problem can be formally described as the need for defining human design criteria, which — if used in the design process - will secure that the systems designed get the relevant qualities. That is not only...... the necessary functional qualities but also the needed human qualities. The author's main argument is, that the design process should be a dialectical synthesis of the two points of view: Man as a System Component, and System as Man's Environment. Based on a man's presentation of the state of the art a set...... of design criteria is suggested and their relevance discussed. The point is to focus on the operator rather than on the computer. The crucial question is not to program the computer to work on its own conditions, but to “program” the operator to function on human conditions....

  6. Intelligent intefrace design criteria

    International Nuclear Information System (INIS)

    Sicard, Y.; Siebert, S.; Thebault, M.H.

    1990-01-01

    Optimum adequation between control means and the capacities of the teams of operators is sought for to achieve computerization of control and monitoring interfaces. Observation of the diagnosis activity of populations of operators in incident situations on a simulator enables design criteria well-suited to the characteristics of the detection, interpretation of symptoms and incident location tasks to be defined. A software tool based on a qualitative approach enables the design process to be systematized

  7. Clinical verification of the superiority of the current International Union Against Cancer staging criteria in an Australian population of patients with nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Corry, J.; Porceddu, S.; Peters, L.J.; Fisher, R.; Rischin, D.

    2004-01-01

    The purpose of this study is to assess the prognostic abilities of the fourth and fifth edition International Union Against Cancer (UICC) staging systems for nasopharyngeal carcinoma (NPC) in Australian patients. All patients planned for curative treatment at the Peter MacCallum Cancer Centre from April 1985 to December 1999 were included in this study. There were 181 patients eligible for this study. The median follow up was 7.6 years. Histological subgroups were World Health Organization (WHO) 1 (23), WHO 2 (12), and WHO 3 (146). Presentation with stage IV disease was 83% by UICC fourth edition staging and 34% by UICC fifth edition staging. The 5 years failure-free survival (FFS) rates for stage 1, 2, 3 and 4 disease by the fourth edition was 77, 100, 93, and 49% respectively,and by the fifth edition was 85, 76. 57 and 36%, respectively. The 5 years overall survival (OS) for stage 1, 2, 3, and 4 disease by the fourth edition was 77. 100, 100 and 61%; respectively.and by the fifth edition was 85, 82, 67 and 53%, respectively. Stage 4 patients by the fourth edition were reclassified as stages 2, 3 and 4 by the fifth edition with hazard ratios of 0.77, 1.01 and 1.79, respectively. In multifactor analysis, the fifth edition staging system was significantly related to FFS and OS after allowing for the fourth edition (FFS: P= 0.002; OS: P = 0.005), but the fourth edition was not significantly related to FFS or OS after allowing for the fifth edition (FFS: P = 0.96; OS: P = 0.96). This study confirms the prognostic superiority of the fifth edition UICC staging system over the fourth edition staging system in an Australian NPC population. Copyright (2004) Blackwell Science Pty Ltd

  8. Verbal learning and memory outcome in selective amygdalohippocampectomy versus temporal lobe resection in patients with hippocampal sclerosis

    DEFF Research Database (Denmark)

    Foged, Mette Thrane; Vinter, Kirsten; Stauning, Louise

    2018-01-01

    1995 and 2009 in Denmark. Exclusion criteria are the following: Intelligence below normal range, right hemisphere dominance, other native languages than Danish, dual pathology, and missing follow-up data. Thus, 56 patients were analyzed. The patients were allocated to SAH (n = 22) or TLR (n = 34) based...... resonance imaging (MRI) signs of dual pathology, selective amygdalohippocampectomy results in sustained seizure freedom and better memory function compared with patients operated with nonselective temporal lobe resection....

  9. Effects of alteplase for acute stroke according to criteria defining the European Union and United States marketing authorizations: Individual-patient-data meta-analysis of randomized trials.

    Science.gov (United States)

    Hacke, Werner; Lyden, Patrick; Emberson, Jonathan; Baigent, Colin; Blackwell, Lisa; Albers, Gregory; Bluhmki, Erich; Brott, Thomas; Cohen, Geoffrey; Davis, Stephen M; Donnan, Geoffrey A; Grotta, James C; Howard, George; Kaste, Markku; Koga, Masatoshi; von Kummer, Rüdiger; Lansberg, Maarten G; Lindley, Richard I; Olivot, Jean-Marc; Parsons, Mark; Sandercock, Peter Ag; Toni, Danilo; Toyoda, Kazunori; Wahlgren, Nils; Wardlaw, Joanna M; Whiteley, William N; Del Zoppo, Gregory; Lees, Kennedy R

    2018-02-01

    Background The recommended maximum age and time window for intravenous alteplase treatment of acute ischemic stroke differs between the Europe Union and United States. Aims We compared the effects of alteplase in cohorts defined by the current Europe Union or United States marketing approval labels, and by hypothetical revisions of the labels that would remove the Europe Union upper age limit or extend the United States treatment time window to 4.5 h. Methods We assessed outcomes in an individual-patient-data meta-analysis of eight randomized trials of intravenous alteplase (0.9 mg/kg) versus control for acute ischemic stroke. Outcomes included: excellent outcome (modified Rankin score 0-1) at 3-6 months, the distribution of modified Rankin score, symptomatic intracerebral hemorrhage, and 90-day mortality. Results Alteplase increased the odds of modified Rankin score 0-1 among 2449/6136 (40%) patients who met the current European Union label and 3491 (57%) patients who met the age-revised label (odds ratio 1.42, 95% CI 1.21-1.68 and 1.43, 1.23-1.65, respectively), but not in those outside the age-revised label (1.06, 0.90-1.26). By 90 days, there was no increased mortality in the current and age-revised cohorts (hazard ratios 0.98, 95% CI 0.76-1.25 and 1.01, 0.86-1.19, respectively) but mortality remained higher outside the age-revised label (1.19, 0.99-1.42). Similarly, alteplase increased the odds of modified Rankin score 0-1 among 1174/6136 (19%) patients who met the current US approval and 3326 (54%) who met a 4.5-h revised approval (odds ratio 1.55, 1.19-2.01 and 1.37, 1.17-1.59, respectively), but not for those outside the 4.5-h revised approval (1.14, 0.97-1.34). By 90 days, no increased mortality remained for the current and 4.5-h revised label cohorts (hazard ratios 0.99, 0.77-1.26 and 1.02, 0.87-1.20, respectively) but mortality remained higher outside the 4.5-h revised approval (1.17, 0.98-1.41). Conclusions An age-revised European Union label or 4

  10. Improved self-exclusion program: preliminary results.

    Science.gov (United States)

    Tremblay, Nicole; Boutin, Claude; Ladouceur, Robert

    2008-12-01

    The gambling industry has offered self-exclusion programs for quite a long time. Such measures are designed to limit access to gaming opportunities and provide problem gamblers with the help they need to cease or limit their gambling behaviour. However, few studies have empirically evaluated these programs. This study has three objectives: (1) to observe the participation in an improved self-exclusion program that includes an initial voluntary evaluation, phone support, and a mandatory meeting, (2) to evaluate satisfaction and usefulness of this service as perceived by self-excluders, (3) to measure the preliminary impact of this improved program. One hundred sixteen self-excluders completed a questionnaire about their satisfaction and their perception of the usefulness during the mandatory meeting. Among those participants, 39 attended an initial meeting. Comparisons between data collected at the initial meeting and data taken at the final meeting were made for those 39 participants. Data showed that gamblers chose the improved self-exclusion program 75% of the time; 25% preferred to sign a regular self-exclusion contract. Among those who chose the improved service, 40% wanted an initial voluntary evaluation and 37% of these individuals actually attended that meeting. Seventy percent of gamblers came to the mandatory meeting, which was a required condition to end their self-exclusion. The majority of participants were satisfied with the improved self-exclusion service and perceived it as useful. Major improvements were observed between the final and the initial evaluation on time and money spent, consequences of gambling, DSM-IV score, and psychological distress. The applicability of an improved self-exclusion program is discussed and, as shown in our study, the inclusion of a final mandatory meeting might not be so repulsive for self-excluders. Future research directives are also proposed.

  11. A review of the concepts of exclusion and exemption

    International Nuclear Information System (INIS)

    Wrixon, A.D.

    2004-01-01

    The concept of exemption has been widely used in radiological protection. It is part of the regulator's arsenal for applying legislative requirements in a graded fashion, to avoid the expenditure of effort on situations where the return in terms of improvement in protection would otherwise be trivial. Nevertheless, it still remains a controversial matter. Perhaps somewhat surprisingly, it is not so much the dosimetric criteria for exemption that cause debate; it is more the way in which the concept is used; the scenarios employed to calculate derived activity concentrations, and its relationship to the somewhat analogous concept of exclusion. Much of the debate regarding the use of the concept and its relationship with exclusion finds its origin in the national legislative culture that has developed over the years in various countries and the inevitable resistance to keep pace with the evolution of the system of radiological protection as recommended by the International Commission on Radiological Protection and implemented through the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources. A particular problem has been the full integration into the legislative system of protection of exposures to radiation from sources of natural origin and the degree to which exemption is a relevant concept for dealing with such situations. The purpose of this paper is to attempt to provide some clarity on the two concepts and their practical implementation with a view to encouraging international harmonization and avoiding further unnecessary debate. (author)

  12. Clinical validation of the C-VAT 2.0 assessment tool for gaming disorder: A sensitivity analysis of the proposed DSM-5 criteria and the clinical characteristics of young patients with 'video game addiction'.

    Science.gov (United States)

    van Rooij, Antonius J; Schoenmakers, Tim M; van de Mheen, Dike

    2017-01-01

    Clinicians struggle with the identification of video gaming problems. To address this issue, a clinical assessment tool (C-VAT 2.0) was developed and tested in a clinical setting. The instrument allows exploration of the validity of the DSM-5 proposal for 'internet gaming disorder'. Using C-VAT 2.0, the current study provides a sensitivity analysis of the proposed DSM-5 criteria in a clinical youth sample (13-23years old) in treatment for video gaming disorder (N=32). The study also explores the clinical characteristics of these patients. The patients were all male and reported spending extensive amounts of time on video games. At least half of the patients reported playing online games (n=15). Comorbid problems were common (n=22) and included (social) anxiety disorders, PDD NOS, ADHD/ADD, Parent-Child relationship problem, and various types of depressive mood problems. The sensitivity of the test was good: results further show that the C-VAT correctly identified 91% of the sample at the proposed cut-off score of at least 5 out of 9 of the criteria. As our study did not include healthy, extreme gamers, we could not assess the specificity of the tool: future research should make this a priority. Using the proposed DSM-5 cut-off score, the C-VAT 2.0 shows preliminary validity in a sample of gamers in treatment for gaming disorder, but the discriminating value of the instrument should be studied further. In the meantime, it is crucial that therapists try to avoid false positives by using expert judgment of functional impairment in each case. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Impact of acute geriatric care in elderly patients according to the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria in northern France.

    Science.gov (United States)

    Frély, Anne; Chazard, Emmanuel; Pansu, Aymeric; Beuscart, Jean-Baptiste; Puisieux, François

    2016-02-01

    In France, over 20% of hospitalizations of elderly people are a result of adverse drug events, of which 50% are considered preventable. Tools have been developed to detect inappropriate prescriptions. The Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria are innovative and adapted to French prescriptions. This is one of the first French prospective studies to evaluate the impact of acute geriatric care on prescriptions at discharge in elderly patients using the STOPP/START criteria. The evaluation of prescriptions according to STOPP/START was carried out on admission and at discharge of patients in acute geriatric units at three hospitals in the Nord-Pas de Calais region, France. A total of 202 elderly hospitalized patients were included during the 4.5 months of the study (1.5 months per center). The mean number of drugs was seven on admission and at discharge. Over half of the prescriptions at admission contained at least one potentially inappropriate medication or one potential prescription omission. The prescriptions at discharge contained significantly fewer potentially inappropriate medications than prescriptions on admission (P < 0.001). In contrast, there was no difference between prescriptions at discharge in terms of potential prescription omissions. Acute geriatric hospitalization in France improves prescriptions in terms of potentially inappropriate medication, but has no impact on potential prescription omissions. Further studies must be carried out to see if STOPP/START could be used as a tool in French prescription. © 2015 Japan Geriatrics Society.

  14. ''Follow that quark!'' (and other exclusive stories)

    International Nuclear Information System (INIS)

    Carroll, A.S.

    1987-01-01

    Quarks are considered to be the basic constituents of matter. In a series of recent experiments, Carroll studied exclusive reactions as a means of determining the interactions between quarks. Quantum Chromo-dynamics (QCD) is the modern theory of the interaction of quarks. This theory explains how quarks are held together via the strong interaction in particles known as hadrons. Hadrons consisting of three quarks are called baryons. Hadrons made up of a quark and an antiquark are called mesons. In his lecture, Carroll describes what happens when two hadrons collide and scatter to large angles. The violence of the collision causes the gluons that bind the quarks in a particular hadron to temporarily lose their grip on particular quarks. Quarks scramble toward renewed unity with other quarks, and they undergo rearrangement, which generally results in additional new particles. A two-body exclusive reaction has occurred when the same number of particles exist before and after the collisions. At large angles these exclusive reactions are very rare. The labels on the quarks known as flavor enable the experimenter to follow the history of individual quarks in detail during these exclusive reactions. Carroll describes the equipment used in the experiment to measure short distance, hard collisions at large angles. The collisions he discusses occur when a known beam of mesons or protons collide with a stationary proton target. Finally, Carroll summarizes what the experiments have shown from the study of exclusive reactions and what light some of their results shed on the theory of QCD

  15. Accuracy and completeness of patient information in organic World-Wide Web search for Mohs surgery: a prospective cross-sectional multirater study using consensus criteria.

    Science.gov (United States)

    Miller, Christopher J; Neuhaus, Isaac M; Sobanko, Joseph F; Veledar, Emir; Alam, Murad

    2013-11-01

    Many patients obtain medical information from the Internet. Inaccurate information affects patient care and perceptions. To assess the accuracy and completeness of information regarding Mohs micrographic surgery (MMS) on the Internet. Prospective cross-sectional Internet-based study reviewing 30 consecutive organic results from three U.S. urban areas on "Mohs surgery" using Google. Text was assessed using a consensus-derived rating scale that quantified necessary and additional or supplementary information about MMS, as well as wrong information. Websites were classified according to type of sponsor. Ninety-one percent of sites conveyed basic information about MMS. There was variation in the mean amount of additional information items (range 0-9) according to website type: 8.4, medical societies; 6.7, academic practices; 5.9, web-based medical information resources; 4.7, private practices; and 4.4, other (p web-based sources (mean 5.11, p web-based medical information sources also provide additional information. © 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

  16. Comparison of the New Adult Ventilator-Associated Event Criteria to the Centers for Disease Control and Prevention Pediatric Ventilator-Associated Pneumonia Definition (PNU2) in a Population of Pediatric Traumatic Brain Injury Patients.

    Science.gov (United States)

    Cirulis, Meghan M; Hamele, Mitchell T; Stockmann, Chris R; Bennett, Tellen D; Bratton, Susan L

    2016-02-01

    The new Centers for Disease Control and Prevention paradigm for ventilator-associated events is intended to simplify surveillance of infectious and noninfectious complications of mechanical ventilation in adults. We assessed the ventilator-associated events algorithm in pediatric patients. A retrospective observational cohort study. This single-center study took place in a PICU at an urban academic medical facility. Pediatric (ages 0-18 yr old) trauma patients with moderate-to-severe traumatic brain injury ventilated for greater than or equal to 2 days. We assessed for pediatric ventilator-associated pneumonia (as defined by current Centers for Disease Control and Prevention PNU2 guidelines), adult ventilator-associated events, and an experimental ventilator-associated events definition modified for pediatric patients. We compared ventilator-associated events to ventilator-associated pneumonia to calculate the test characteristics. Thirty-nine of 119 patients (33%) developed ventilator-associated pneumonia. Sensitivity of the adult ventilator-associated condition definition was 23% (95% CI, 11-39%), which increased to 56% (95% CI, 40-72%) using the modified pediatric ventilator-associated pneumonia criterion. Specificity reached 100% for both original and modified pediatric probable ventilator-associated pneumonia using ventilator-associated events criteria. Children who developed ventilator-associated pneumonia or ventilator-associated condition had similar baseline characteristics: age, mechanism of injury, injury severity scores, and use of an intracranial pressure monitor. Diagnosis of ventilator-associated pneumonia and ventilator-associated condition portended similarly unfavorable outcomes: longer median duration of ventilation, ICU and hospital length of stay, and more discharges to rehabilitation, home health, or nursing care compared with patients with no pulmonary complication. Both current and modified ventilator-associated events criteria have poor

  17. Testing the Pauli Exclusion Principle for Electrons

    International Nuclear Information System (INIS)

    Marton, J; Berucci, C; Cargnelli, M; Ishiwatari, T; Bartalucci, S; Bragadireanu, M; Curceanu, C; Guaraldo, C; Iliescu, M; Pietreanu, D; Piscicchia, K; Ponta, T; Vidal, A Romero; Scordo, A; Sirghi, D L; Bertolucci, S; Matteo, S Di; Egger, J-P; Laubenstein, M; Milotti, E

    2013-01-01

    One of the fundamental rules of nature and a pillar in the foundation of quantum theory and thus of modern physics is represented by the Pauli Exclusion Principle. We know that this principle is extremely well fulfilled due to many observations. Numerous experiments were performed to search for tiny violation of this rule in various systems. The experiment VIP at the Gran Sasso underground laboratory is searching for possible small violations of the Pauli Exclusion Principle for electrons leading to forbidden X-ray transitions in copper atoms. VIP is aiming at a test of the Pauli Exclusion Principle for electrons with high accuracy, down to the level of 10 −29 – 10 −30 , thus improving the previous limit by 3–4 orders of magnitude. The experimental method, results obtained so far and new developments within VIP2 (follow-up experiment at Gran Sasso, in preparation) to further increase the precision by 2 orders of magnitude will be presented

  18. Digital exclusion in higher education contexts

    DEFF Research Database (Denmark)

    Khalid, Md. Saifuddin; Pedersen, Mette Jun Lykkegaard

    2016-01-01

    The integration and adoption of digital technologies have enabled improvements in the quality of and inclusion in higher education. However, a significant proportion of the population has either remained or become digitally excluded. This systematic literature review elucidates the factors...... underlying the concepts of “digital exclusion” and the “digital divide” in higher education. The identified factors are grouped into three categories: social exclusion (i.e., low income, ICT-avoidance as the norm, lack of motivation and commitment, and physical or mental disability), digital exclusion (i.......e., lack of hardware devices and Internet services) and accessibility (which include the division between rural and urban areas, as well as disparities in ICT literacy and information literacy). These factors are multi-tiered and overlapping. Studies on the digital divide, digital exclusion, and barriers...

  19. Exclusive vector meson production at HERA

    Energy Technology Data Exchange (ETDEWEB)

    Szuba, Dorota [Hamburg University, Hamburg (Germany); Collaboration: H1 Collaboration; ZEUS Collaboration

    2013-04-15

    The exclusive photoproduction of {Upsilon} has been studied with the ZEUS detector in ep collisions at HERA. The exponential slope, b, of the |t|-dependence of the cross section, where t is the squared four-momentum transfer at the proton vertex, has been measured. This constitutes the first measurement of the |t|-dependence of the {gamma}p{yields}{Upsilon}p cross section. The differential crosssections as a function of t at lower energies of {gamma}p centre-of-mass has been studied in exclusive diffractive photoproduction of J/{psi} mesons with the H1 detector. The exclusive electroproduction of two pions has been measured by the ZEUS experiment. The two-pion invariant-mass distribution is interpreted in terms of the pion electromagnetic form factor, assuming that the studied mass range includes the contributions of the {rho}, {rho} Prime and . {rho}'' vector-meson states.

  20. Exclusive vector meson production at HERA

    International Nuclear Information System (INIS)

    Szuba, Dorota

    2013-01-01

    The exclusive photoproduction of Υ has been studied with the ZEUS detector in ep collisions at HERA. The exponential slope, b, of the |t|-dependence of the cross section, where t is the squared four-momentum transfer at the proton vertex, has been measured. This constitutes the first measurement of the |t|-dependence of the γp→Υp cross section. The differential crosssections as a function of t at lower energies of γp centre-of-mass has been studied in exclusive diffractive photoproduction of J/ψ mesons with the H1 detector. The exclusive electroproduction of two pions has been measured by the ZEUS experiment. The two-pion invariant-mass distribution is interpreted in terms of the pion electromagnetic form factor, assuming that the studied mass range includes the contributions of the ρ, ρ′ and . ρ'' vector-meson states.

  1. Criteria for software modularization

    Science.gov (United States)

    Card, David N.; Page, Gerald T.; Mcgarry, Frank E.

    1985-01-01

    A central issue in programming practice involves determining the appropriate size and information content of a software module. This study attempted to determine the effectiveness of two widely used criteria for software modularization, strength and size, in reducing fault rate and development cost. Data from 453 FORTRAN modules developed by professional programmers were analyzed. The results indicated that module strength is a good criterion with respect to fault rate, whereas arbitrary module size limitations inhibit programmer productivity. This analysis is a first step toward defining empirically based standards for software modularization.

  2. Prevalence and predictors of exclusive breastfeeding at hospital discharge.

    Science.gov (United States)

    McDonald, Sarah D; Pullenayegum, Eleanor; Chapman, Barbara; Vera, Claudio; Giglia, Lucia; Fusch, Christoph; Foster, Gary

    2012-06-01

    To estimate the population-based prevalence and predictors of exclusive breastfeeding at hospital discharge in singleton and twin term newborns. We studied all hospital births in the province of Ontario, Canada, between April 1, 2009, and March 31, 2010, to perform a retrospective cohort study. We included live singleton and twin births, at term (37 0/7 weeks of gestation to 41 6/7 weeks of gestation), with information about feeding at maternal-newborn discharge. Descriptive statistics were performed and logistic regression was used to identify factors related to exclusive breastfeeding. Our study population consisted of 92,364 newborns, of whom 56,865 (61.6%) were exclusively breastfed at discharge. Older, nonsmoking, higher-income mothers with no pregnancy complications or reproductive assistance were more likely to breastfeed. Mothers of twins were less likely to exclusively breastfeed (adjusted odds ratio [OR] 0.30, 95% confidence interval [CI] 0.25-0.36) as were women who did not attend prenatal classes (adjusted OR 0.80, 95% CI 0.76-0.83). Compared with patients of obstetricians (57%), women cared for by midwives (87%, adjusted OR 4.49, 95% CI 4.16-4.85) and family physicians (67%, adjusted OR 1.54, 95% CI 1.47-1.61) were more likely to exclusively breastfeed. Breastfeeding after a planned (50%, adjusted OR 0.56, 95% CI 0.52-0.60) or unplanned (48%, adjusted OR 0.48, 95% CI 0.44-0.51) cesarean delivery was less common than after a spontaneous vaginal birth (68%). Neonates born at 39, 38, and 37 weeks of gestation (compared with 41 weeks of gestation) were increasingly less likely to breastfeed (adjusted ORs 0.93, 95% CI 0.89-0.98; 0.84, 95% CI 0.80-0.88; and 0.71, 95% CI 0.67-0.76). This large population-based study found that fewer than two thirds of term newborns are exclusively breastfed at hospital discharge, substantially lower than previously reported. II.

  3. Evidence-based medical research on diagnostic criteria and screening technique of vascular mild cognitive impairment

    Directory of Open Access Journals (Sweden)

    Xia-wei LIU

    2015-07-01

    Full Text Available Background Vascular mild cognitive impairment (VaMCI is the prodromal syndrome of vascular dementia (VaD and key target for drug treatment. There is controversy over the diagnostic criteria and screening tools of VaMCI, which affects its clinical diagnosis. This paper aims to explore the clinical features, diagnostic criteria and screening technique of VaMCI.  Methods Taking "vascular mild cognitive impairment OR vascular cognitive impairment no dementia" as retrieval terms, search in PubMed database from January 1997 to March 2015 and screen relevant literatures concerning VaMCI. According to Guidance for the Preparation of Neurological Management Guidelines revised by European Federation of Neurological Societies (EFNS in 2004, evidence grading was performed on literatures. Results A total of 32 literatures in English were selected according to inclusion and exclusion criteria, including 3 guidelines and consensus and 29 clinical studies. Seven literatures (2 on Level Ⅰ, 5 on Level Ⅱ studied on neuropsychological features in VaMCI patients and found reduced processing speed and executive function impairment were main features. Two literatures reported the diagnostic criteria of VaMCI, including VaMCI criteria published by American Heart Association (AHA/American Stroke Association (ASA in 2011 and "Diagnostic Criteria for Vascular Cognitive Disorders" published by International Society for Vascular Behavioral and Cognitive Disorders (VASCOG in 2014. Fifteen literatures (4 on LevelⅠ, 11 on Level Ⅱ described the diagnostic criteria of VaMCI used in clinical research, from which 6 operational diagnostic items were extracted. Fourteen literatures (4 on Level Ⅰ, 10 on Level Ⅱ described neuropsychological assessment tools for VaMCI screening, and found the 5-minute protocol recommended by National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN was being good consistency with other neuropsychological

  4. Teenage pregnancy and exclusive breastfeeding rates.

    Science.gov (United States)

    Puapompong, Pawin; Raungrongmorakot, Kasem; Manolerdtewan, Wichian; Ketsuwan, Sukwadee; Wongin, Sinutchanan

    2014-09-01

    Teenage pregnancy is an important health issue globally and in Thailand Younger age mothers decide on the breastfeeding practices ofthe first 6-month. To find the rates of 6-month exclusive breastfeeding practices of teenage mothers and compare them with the rates of 6-month exclusive breastfeeding practices in mothers who are 20 years of age or more. Three thousand five hundred sixty three normal, postpartum women, who delivered without complications at the HRH Princess Maha Chakri Sirindhorn Medical Center in the Nakhon Nayok Province between 2010 and2013 were included in this study. At the second daypostpartum, the data of latch scores and the data of the practice of exclusive breastfeeding were collected Telephone follow-ups on the seventh, fourteenth, and forty-fifth postpartum days and at the second, fourth, and sixth month postpartum month were collected and used for exclusive breastfeeding data following discharge. Demographic data included the maternal age, parity, gestational age, marital status, occupation, religion, route ofdelivery, estimated blood loss, body mass index, nipple length, and the childs birth weight. The collected data was analyzed by the t-test, Chi-square, and odds ratio with 95% confidence interval. The percentage of teenage pregnancies was at 14.8% (527 cases). On postpartum day 2, the percentage of latch scores of 8 or less was 66.4%. At the seventh, fourteenth, and forty-fifth day and at the second, fourth, and sixth months postpartum, the exclusive breastfeeding rates were 88.5, 78.5, 57.6, 43.1, 32.9, and27.0%, respectively. Comparison of the 6-month exclusive breastfeeding rates between teenage mothers and mothers 20 years ofage or older were not statistically significant (pteenage mothers was at 27.0% and had no significant differences from the rates of mothers 20 years of age or more.

  5. Barriers to Exclusive Breastfeeding among Urban Mothers

    Directory of Open Access Journals (Sweden)

    Lazina Sharmin

    2016-05-01

    Full Text Available Background: Breastfeeding is the unique source of nutrition and it plays an important role in the growth, development and survival of the infants. The initiation of breastfeeding within one hour and continuation of only breast milk up to six months ensure maximum benefits. The prevalence of exclusive breastfeeding in Bangladesh is 56% which is low. We designed this study to find out the factors influencing the duration of breastfeeding in Bangladeshi population. Objective: To study the factors influencing noncompliance to exclusive breastfeeding. Materials and Methods: This cross sectional study was conducted in Dhaka Shishu Hospital during the period January to June 2011. It includes 125 infant (1–12 months-mother pairs randomly selected from the inpatient and outpatient departments of Dhaka Shishu Hospital. Mother-infant pairs were divided into two groups based on continuation of only breastfeeding up to six months. Outcomes were compared between two groups. Results: In this study exclusive breastfeeding was found in 27.2% and nonexclusive breastfeeding was in 72.8% cases. It was found that in most cases (40% termination of breastfeeding was at 3--4 months. The study revealed that insufficient milk production due to poor position and attachment, social factors such as influence of husband and other family members, joining to service etc act as barrier to exclusive breastfeeding. Mass media and advice from health professionals had a higher influence on lower rate of exclusive breastfeeding. Women who were multiparous, housewives were more likely to maintain optimal breastfeeding. Conclusion: The present study reveals some important factors contributing to low rate of exclusive breastfeeding in Bangladesh.

  6. 78 FR 55687 - Notice of Intent To Grant an Exclusive, Partially Exclusive or Non-Exclusive License of the...

    Science.gov (United States)

    2013-09-11

    ... DEPARTMENT OF DEFENSE Department of the Army Notice of Intent To Grant an Exclusive, Partially..., 2012 Entitled ''Tie-Down and Jack Fitting Assembly for Helicopter'' AGENCY: Department of the Army, [email protected]us.army.mil . SUPPLEMENTARY INFORMATION: The patent application relates to the aviation platforms...

  7. Use of Metabolomics as a Complementary Omic Approach to Implement Risk Criteria for First-Degree Relatives of Gastric Cancer Patients

    Directory of Open Access Journals (Sweden)

    Giuseppe Corona

    2018-03-01

    Full Text Available A positive family history is a strong and consistently reported risk factor for gastric cancer (GC. So far, it has been demonstrated that serum pepsinogens (PGs, and gastrin 17 (G17 are useful for screening individuals at elevated risk to develop atrophic gastritis but they are suboptimal biomarkers to screen individuals for GC. The main purpose of this study was to investigate serum metabolomic profiles to find additional biomarkers that could be integrated with serum PGs and G17 to improve the diagnosis of GC and the selection of first-degree relatives (FDR at higher risk of GC development. Serum metabolomic profiles included 188 serum metabolites, covering amino acids, biogenic amines, acylcarnitines, phosphatidylcholines, sphingomyelins and hexoses. Serum metabolomic profiles were performed with tandem mass spectrometry using the Biocrates AbsoluteIDQ p180 kit. The initial cohort (training set consisted of n = 49 GC patients and n = 37 FDR. Differential metabolomic signatures among the two groups were investigated by univariate and multivariate partial least square differential analysis. The most significant metabolites were further selected and validated in an independent group of n = 22 GC patients and n = 17 FDR (validation set. Receiver operating characteristic (ROC curves were used to evaluate the diagnostic power and the optimal cut-off for each of the discriminant markers. Multivariate analysis was applied to associate the selected serum metabolites, PGs, G17 and risk factors such as age, gender and Helicobacter pylori (H. pylori infection with the GC and FDR has been performed and an integrative risk prediction algorithm was developed. In the training set, 40 metabolites mainly belonging to phospholipids and acylcarnitines classes were differentially expressed between GC and FDR. Out of these 40 metabolites, 9 were further confirmed in the validation set. Compared with FDR, GC patients were characterized by lower levels of

  8. Exclusive B Decays to Charmonium Final States

    Energy Technology Data Exchange (ETDEWEB)

    Barrera, Barbara

    2000-10-13

    We report on exclusive decays of B mesons into final states containing charmonium using data collected with the BABAR detector at the PEP-II storage rings. The charmonium states considered here are J/{psi}, {psi}(2S), and {chi}{sub c1}. Branching fractions for several exclusive final states, a measurement of the decay amplitudes for the B{sup 0} {yields} J/{psi} K* decay, and measurements of the B{sup 0} and B{sup +} masses are presented. All of the results we present here are preliminary.

  9. Exclusive hadronic and nuclear processes in QCD

    International Nuclear Information System (INIS)

    Brodsky, S.J.

    1985-12-01

    Hadronic and nuclear processes are covered, in which all final particles are measured at large invariant masses compared with each other, i.e., large momentum transfer exclusive reactions. Hadronic wave functions in QCD and QCD sum rule constraints on hadron wave functions are discussed. The question of the range of applicability of the factorization formula and perturbation theory for exclusive processes is considered. Some consequences of quark and gluon degrees of freedom in nuclei are discussed which are outside the usual domain of traditional nuclear physics. 44 refs., 7 figs

  10. Exclusion Statistics in Conformal Field Theory Spectra

    International Nuclear Information System (INIS)

    Schoutens, K.

    1997-01-01

    We propose a new method for investigating the exclusion statistics of quasiparticles in conformal field theory (CFT) spectra. The method leads to one-particle distribution functions, which generalize the Fermi-Dirac distribution. For the simplest SU(n) invariant CFTs we find a generalization of Gentile parafermions, and we obtain new distributions for the simplest Z N -invariant CFTs. In special examples, our approach reproduces distributions based on 'fractional exclusion statistics' in the sense of Haldane. We comment on applications to fractional quantum Hall effect edge theories. copyright 1997 The American Physical Society

  11. The effect of biofeedback therapy on dyssynergic constipation in patients with or without Irritable Bowel Syndrome

    OpenAIRE

    Tannaz Ahadi; Faezeh Madjlesi; Bahar Mahjoubi; Rezvan Mirzaei; Bijan Forogh; Seyedeh Somayeh Daliri; Seyed Majid Derakhshandeh; Roxana Bazaz Behbahani; G Reza Raissi

    2014-01-01

    Background: The Rome II and III diagnostic criteria for dyssynergic defecation recommended the exclusion of irritable bowel syndrome (IBS). This study determined the effect of biofeedback therapy on dyssynergic constipation in patients with or without IBS. Materials and Methods: This study was a nonrandomized, single blinded, semi experimental study. Dyssynergic defecation patients with and without IBS were asked to undergo biofeedback therapy 8 sessions. The defecation dynamics and balloon e...

  12. Mindfulness-based cognitive therapy in patients with late-life depression: A case series

    OpenAIRE

    Sonal Mathur; Mahendra Prakash Sharma; Srikala Bharath

    2016-01-01

    Depression is the most common mental illness in the elderly, and cost-effective treatments are required. Therefore, this study is aimed at evaluating the effectiveness of a mindfulness-based cognitive therapy (MBCT) on depressive symptoms, mindfulness skills, acceptance, and quality of life across four domains in patients with late-onset depression. A single case design with pre- and post-assessment was adopted. Five patients meeting the specified inclusion and exclusion criteria were recruit...

  13. Preliminary classification criteria for the antiphospholipid syndrome within systemic lupus erythematosus.

    Science.gov (United States)

    Alarcón-Segovia, D; Pérez-Vázquez, M E; Villa, A R; Drenkard, C; Cabiedes, J

    1992-04-01

    Ten percent of 667 consecutive systemic lupus erythematosus (SLE) patients were considered to have definite antiphospholipid syndrome (aPLS) because they had two or more antiphospholipid (aPL)-related clinical manifestations and aPL titers more than 5 SD above the mean of normal controls. Another 14% had either one aPL-related manifestation but high titers of the antibody or two manifestations and low aPL titers (probable aPLS). One fourth of the patients had no manifestations but high titers, one manifestation and low titers, or two or more manifestations and negative aPL titers ("doubtful" aPLS); the other half were considered negative for aPLS. In patients with high-titer aPL, the number of aPL-related manifestations was influenced by disease duration and number of pregnancies, indicating potential mobility of category with time or with risk of recurrent pregnancy loss. Patients with two or more manifestations but variable aPL levels differed in immunosuppressive treatment and in the number of times they had been tested, indicating potential mobility of category with lower treatment and/or further aPL testing. Patients with definite aPLS had increased risk of cutaneous vasculitis, peripheral neuropathy, seizures, psychosis, transient ischemic attacks, and leukopenia. In 11 of 52 SLE patients with definite aPLS the initial manifestation was related to aPL, and in 16 it concurred with an unrelated one. Only two patients fulfilled criteria for aPLS before having other evidence of SLE. The authors conclude that aPLS occurring within SLE is part of the disease rather than an associated condition and propose the use of definite and probable classification categories. These criteria, with appropriate follow-up and clinical and serological exclusion clauses for potential primary conditions, could also be applied to primary aPLS.

  14. Safety and reliability criteria

    International Nuclear Information System (INIS)

    O'Neil, R.

    1978-01-01

    Nuclear power plants and, in particular, reactor pressure boundary components have unique reliability requirements, in that usually no significant redundancy is possible, and a single failure can give rise to possible widespread core damage and fission product release. Reliability may be required for availability or safety reasons, but in the case of the pressure boundary and certain other systems safety may dominate. Possible Safety and Reliability (S and R) criteria are proposed which would produce acceptable reactor design. Without some S and R requirement the designer has no way of knowing how far he must go in analysing his system or component, or whether his proposed solution is likely to gain acceptance. The paper shows how reliability targets for given components and systems can be individually considered against the derived S and R criteria at the design and construction stage. Since in the case of nuclear pressure boundary components there is often very little direct experience on which to base reliability studies, relevant non-nuclear experience is examined. (author)

  15. Perspectives on the revised Ghent criteria for the diagnosis of Marfan syndrome

    Directory of Open Access Journals (Sweden)

    von Kodolitsch Y

    2015-06-01

    diagnostic criteria include acceptance by patients, patient organizations, clinicians and scientists, practicability, costs, and the reduction of anxiety. Since the utility of a diagnosis or exclusion of MFS is context-dependent, prioritization of utilities is a strategic decision in the process of nosology development. Screening tests for MFS should be used to identify persons with MFS. To confirm the diagnosis of MFS, Ghent-1 and Ghent-2 perform similarly, but Ghent-2 is easier to use. To maximize the utility of the diagnostic criteria of MFS, a fair and transparent process of nosology development is essential. Keywords: Marfan syndrome, Ghent nosology, diagnosis, FBN1, mutation, aorta

  16. Comparing new diagnostic criteria of 2010 ACR/EULAR with 1987 ACR criteria in rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Fatemeh Shirani

    2017-01-01

    Full Text Available Background: Rheumatoid Arthritis (RA is a chronic inflammatory disease presenting with inflammation, tenderness and destruction of the synovial joints, resulting in severe disability and early death due to complication of disease. Previous diagnostic criteria are not useful for identifying patients who need early treatment. Thus, new diagnostic criteria for faster diagnosis of disease are introduced in 2010. The aim of this study was to compared 1987 ACR (American College of Rheumatology criteria and 2010 ACR/EULAR (European League Against Rheumatism classification criteria for diagnosis of rheumatoid arthritis. Methods: In this Cohort prospective study, patients with early arthritis were evaluated   according to the old and new diagnostic criteria and followed-up every two monthly for one year (2012-2013 in Hazrat-e Rasool University Hospital, Tehran. Inclusion criteria of this study were age more than 18 year and indefinite diagnosis of arthritis. For all of patients physical examination by expert rheumatologist was done and lab data include erythrocyte sedimentation rate (ESR, C-reactive protein (CRP, anti-cyclic citrullinated peptide (Anti-CCP and rheumatoid factor was requested. The sensitivity, specificity, positive and negative predictive values were then determined for each diagnostic criteria. Results: In this study 104 patients including 28 males (26.9% and 76 females (73.1% with the mean age of 44.2±13.7 years were included. At the end of one year follow-up, 82 were diagnosed to have RA while other 22 patients were not categorized as RA. Sensitivity for ESR, CRP, Anti-CCP and rheumatoid factor in 2010 ACR/EULAR criteria was 52%, 19%, 48%, 28% and specificity for them was 45%, 71%, 27%, 79% respectively. Number of small and large joint arthritis were more in patients with Rheumatoid Arthritis (RA rather than other arthritis (P=0.0001. Sensitivity and specificity for small joints involvement was 87% and 54% and for large joints

  17. Laser Safety Inspection Criteria

    International Nuclear Information System (INIS)

    Barat, K

    2005-01-01

    A responsibility of the Laser Safety Officer (LSO) is to perform laser safety audits. The American National Standard Z136.1 Safe use of Lasers references this requirement in several sections: (1) Section 1.3.2 LSO Specific Responsibilities states under Hazard Evaluation, ''The LSO shall be responsible for hazards evaluation of laser work areas''; (2) Section 1.3.2.8, Safety Features Audits, ''The LSO shall ensure that the safety features of the laser installation facilities and laser equipment are audited periodically to assure proper operation''; and (3) Appendix D, under Survey and Inspections, it states, ''the LSO will survey by inspection, as considered necessary, all areas where laser equipment is used''. Therefore, for facilities using Class 3B and or Class 4 lasers, audits for laser safety compliance are expected to be conducted. The composition, frequency and rigueur of that inspection/audit rests in the hands of the LSO. A common practice for institutions is to develop laser audit checklists or survey forms. In many institutions, a sole Laser Safety Officer (LSO) or a number of Deputy LSO's perform these audits. For that matter, there are institutions that request users to perform a self-assessment audit. Many items on the common audit list and the associated findings are subjective because they are based on the experience and interest of the LSO or auditor in particular items on the checklist. Beam block usage is an example; to one set of eyes a particular arrangement might be completely adequate, while to another the installation may be inadequate. In order to provide more consistency, the National Ignition Facility Directorate at Lawrence Livermore National Laboratory (NIF-LLNL) has established criteria for a number of items found on the typical laser safety audit form. These criteria are distributed to laser users, and they serve two broad purposes: first, it gives the user an expectation of what will be reviewed by an auditor, and second, it is an

  18. National Recommended Water Quality Criteria

    Data.gov (United States)

    U.S. Environmental Protection Agency — The National Recommended Water Quality Criteria is a compilation of national recommended water quality criteria for the protection of aquatic life and human health...

  19. Exclusive breastfeedingand postnatal changes in maternal ...

    African Journals Online (AJOL)

    To evaluate the impact of exclusive breastfeeding (EBFing) practice on maternal anthropometry during the first 6months of birth. Measurement of weight, height, triceps skin-fold thickness (TST), and mid-arm circumference (MAC) was carried out in a matched cohort of women practicing EBFing and those using other ...

  20. Determinants of exclusive breastfeeding practices in Ethiopia ...

    African Journals Online (AJOL)

    Background: Despite the demonstrated benefits of breast milk, the prevalence of breastfeeding, in-particular exclusive breastfeeding (EBF), in many developing countries including Ethiopia is lower than the international recommendation of EBF for the first six months of life. Objective: To assess the practice of EBF and ...

  1. 40 CFR 503.6 - Exclusions.

    Science.gov (United States)

    2010-07-01

    ... treatment of domestic sewage in a treatment works. (i) Drinking water treatment sludge. This part does not... water or ground water used for drinking water. (j) Commercial and industrial septage. This part does not... DISPOSAL OF SEWAGE SLUDGE General Provisions § 503.6 Exclusions. (a) Treatment processes. This part does...

  2. Sexism and Permanent Exclusion from School

    Science.gov (United States)

    Carlile, Anna

    2009-01-01

    Focussing on narratives collected during a two year participant observation research project in the children's services department of an urban local authority, this article addresses the intersection between incidents of permanent exclusion from school and assumptions made on the basis of a young person's gender. The article considers gendered…

  3. Knowledge, Attitude and Practice Towards Exclusive Breast ...

    African Journals Online (AJOL)

    Knowledge, Attitude and Practice Towards Exclusive Breast-Feeding At Jimma, Ethiopia. Teklebrhan Tema. Abstract. No abstract - Available on PDF. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL.

  4. Exclusive production of W pairs in CMS

    CERN Document Server

    INSPIRE-00002838

    2014-01-01

    We report the results on the search for exclusive production of $W$ pairs in the LHC with data collected by the Compact Muon Solenoid detector in proton-proton collisions at $\\sqrt{s}$~=~7~TeV. The analysis comprises the two-photon production of a $W$ pairs, ${pp\\to p\\,W^{+}W^{-}\\,p\\to p\\,\

  5. Exclusive processes in pp collisions in CMS

    CERN Document Server

    Da Silveira, Gustavo Gil

    2013-01-01

    We report the results on the searches of exclusive production of low- and high-mass pairs with the Compact Muon Solenoid (CMS) detector in proton-proton collisions at $\\sqrt{s}$ = 7 TeV. The analyses comprise the central exclusive $\\gamma\\gamma$ production, the exclusive two-photon production of dileptons, $e^{+}e^{-}$ and $\\mu^{+}\\mu^{-}$, and the exclusive two-photon production of $W$ pairs in the asymmetric $e^{\\pm}\\mu^{\\mp}$ decay channel. No diphotons candidates are observed in data and an upper limit on the cross section is set to 1.18 pb with 95% confidence level for $E_{T}(\\gamma)>$ 5.5 GeV and $|\\eta(\\gamma)|$ 5.5 GeV and $|\\eta(e)|$ 11.5 GeV, $p_{\\textrm{T}}(\\mu)>$ 4 GeV and $|\\eta(\\mu)|$ 4 GeV, $|\\eta(\\mu)|$ 20 GeV. Moreover, the study of the tail of the dilepton transverse momentum distribution resulted in model-independent upper limits for the anomalous quartic gauge couplings, which are of the order of 10$^{-4}$.

  6. Exclusive production of $W$ pairs in CMS

    OpenAIRE

    Da Silveira, Gustavo Gil; CMS

    2014-01-01

    We report the results on the search for exclusive production of $W$ pairs in the LHC with data collected by the Compact Muon Solenoid detector in proton-proton collisions at $\\sqrt{s}$~=~7~TeV. The analysis comprises the two-photon production of a $W$ pairs, ${pp\\to p\\,W^{+}W^{-}\\,p\\to p\\,\

  7. Starvation-free mutual exclusion with semaphores

    NARCIS (Netherlands)

    Hesselink, Wim H.; IJbema, Mark

    The standard implementation of mutual exclusion by means of a semaphore allows starvation of processes. Between 1979 and 1986, three algorithms were proposed that preclude starvation. These algorithms use a special kind of semaphore. We model this so-called buffered semaphore rigorously and provide

  8. Deadlocks and dihomotopy in mutual exclusion models

    DEFF Research Database (Denmark)

    Raussen, Martin

    2005-01-01

    spaces, the directed ($d$-spaces) of M.Grandis and the flows of P. Gaucher. All models invite to use or modify ideas from algebraic topology, notably homotopy. In specific semaphore models for mutual exclusion, we have developed methods and algorithms that can detect deadlocks and unsafe regions and give...

  9. Counterfactual overdetermination vs. the causal exclusion problem.

    Science.gov (United States)

    Sparber, Georg

    2005-01-01

    This paper aims to show that a counterfactual approach to causation is not sufficient to provide a solution to the causal exclusion problem in the form of systematic overdetermination. Taking into account the truthmakers of causal counterfactuals provides a strong argument in favour of the identity of causes in situations of translevel, causation.

  10. Factors associated with exclusive breastfeeding among mothers ...

    African Journals Online (AJOL)

    Conclusion: This study could help mothers, Ministry of Health and other nongovernmental organisations working with child health programmes, in likely interventions and supporting the ongoing child survival programmes, by taking appropriate steps in enhancing exclusive breastfeeding. As mothers attend antenatal and ...

  11. 46 CFR 504.4 - Categorical exclusions.

    Science.gov (United States)

    2010-10-01

    ... FEDERAL MARITIME COMMISSION GENERAL AND ADMINISTRATIVE PROVISIONS PROCEDURES FOR ENVIRONMENTAL POLICY ANALYSIS § 504.4 Categorical exclusions. (a) No environmental analyses need be undertaken or environmental... foreign country. (19) Action taken on special docket applications pursuant to § 502.271 of this chapter...

  12. 10 CFR 830.2 - Exclusions.

    Science.gov (United States)

    2010-01-01

    ... by the Department of Transportation; (d) Activities conducted under the Nuclear Waste Policy Act of... ENERGY NUCLEAR SAFETY MANAGEMENT § 830.2 Exclusions. This part does not apply to: (a) Activities that are regulated through a license by the Nuclear Regulatory Commission (NRC) or a State under an Agreement with...

  13. Testing the exclusivity effect in location memory.

    Science.gov (United States)

    Clark, Daniel P A; Dunn, Andrew K; Baguley, Thom

    2013-01-01

    There is growing literature exploring the possibility of parallel retrieval of location memories, although this literature focuses primarily on the speed of retrieval with little attention to the accuracy of location memory recall. Baguley, Lansdale, Lines, and Parkin (2006) found that when a person has two or more memories for an object's location, their recall accuracy suggests that only one representation can be retrieved at a time (exclusivity). This finding is counterintuitive given evidence of non-exclusive recall in the wider memory literature. The current experiment explored the exclusivity effect further and aimed to promote an alternative outcome (i.e., independence or superadditivity) by encouraging the participants to combine multiple representations of space at encoding or retrieval. This was encouraged by using anchor (points of reference) labels that could be combined to form a single strongly associated combination. It was hypothesised that the ability to combine the anchor labels would allow the two representations to be retrieved concurrently, generating higher levels of recall accuracy. The results demonstrate further support for the exclusivity hypothesis, showing no significant improvement in recall accuracy when there are multiple representations of a target object's location as compared to a single representation.

  14. Bitcoin and Beyond: Exclusively Informational Money

    NARCIS (Netherlands)

    Bergstra, J.A.; de Leeuw, K.

    2013-01-01

    The famous new money Bitcoin is classified as a technical informational money (TIM). Besides introducing the idea of a TIM, a more extreme notion of informational money will be developed: exclusively informational money (EXIM). The informational coins (INCOs) of an EXIM can be in control of an agent

  15. Urban violence and exclusion in the DRC

    International Development Research Centre (IDRC) Digital Library (Canada)

    support, children from impoverished households, many of whom are uneducated, are adding to the ... The goal of this study was to identify the dynamic interplay among poverty/exclusion ... The lack of public lighting and access points to water exposes girls to .... work together to develop more inclusive economic and social.

  16. 40 CFR 68.126 - Exclusion.

    Science.gov (United States)

    2010-07-01

    ... ACCIDENT PREVENTION PROVISIONS Regulated Substances for Accidental Release Prevention § 68.126 Exclusion. Flammable Substances Used as Fuel or Held for Sale as Fuel at Retail Facilities. A flammable substance... substance is used as a fuel or held for sale as a fuel at a retail facility. [65 FR 13250, Mar. 13, 2000] ...

  17. The Exclusive Pursuit of Social Inclusion

    Science.gov (United States)

    Goodson, Ivor

    2005-01-01

    Despite its best intentions, social exclusion has grown rather than diminished under New Labour's education policies. In order to understand this, Ivor Goodson argues that we need to engage with the history of the formal curriculum and the long and continuing fight over what counts as proper knowledge. Taking science and e