39 research outputs found
Clinical Decision Support Systems: should we rely on unvalidated tools?
No full textClinical decision-making is an essential aspect of surgical practice, and requires the integration of patient specific information with a large and multidimensional knowledge base.1 Clinical decision support systems (CDSS) are computerized tools that are designed to assist clinicians by integrating data from multiple sources to provide patient-specific advice.2 CDSS, such as test result prompts and prognostic calculators, are already used by surgeons on a daily basis. ..
Cognitive load measurements and stimulated recall interviews for studying the effects of information and communications technology
No full textMany researchers use information and communications technology (ICT)-tools to augment learning in a great variety of tasks. Their effects are generally measured in terms of intended outcomes. This article argues for the use of additional, more general measures to obtain a more complete impression of the effects of ICT-tools. The first study presented in this article shows why tools should not only be studied in terms of their specific intended outcomes, but also in terms of their effects on working memory, and the cognitive mechanisms needed to achieve the intended outcomes. The second study uses cognitive load measurements and stimulated recall interviews to obtain a more comprehensive view of the effects of learning tools. Results suggest that traditional outcome measures need to be complemented with quantitative and qualitative measures of cognitive processes to substantiate conclusions about intended effects of ICT-tools.Technology, Policy and Managemen
Anastomotic leakage after lower gastrointestinal anastomosis
No full textBackground: Anastomotic leakage is the most important complication specific to intestinal surgery. The aim of this study was to review the anastomotic leakage rates in a single Colorectal Unit and to evaluate the risk factors for anastomotic leakage after lower gastrointestinal anastomosis. Methods: A total of 541 consecutive operations involving anastomoses of the colon and rectum that were carried out between 1999 and 2004 at a single colorectal unit were reviewed. Data concerning 35 variables, relating to patient, tumour and surgical factors, were recorded. Outcomes with respect to anastomotic leakage and mortality were recorded. Data were analysed using univariate and multivariate analyses and odds ratios (OR) calculated. Results: The overall rate of anastomotic leakage was 6.5% (35 of 541). The most frequently carried out operations were right hemicolectomy and anterior resection of the rectum, with leak rates of 2.2 and 7.4%, respectively. Univariate analysis showed that male gender (OR = 3.5), previous abdominal surgery (OR = 2.4), Crohn’s disease (OR = 3.3), rectal cancer ≤12 cm from the anal verge (OR = 5.4) and prolonged operating time (OR = 2.8) were factors significantly associated with anastomotic leakage. Male gender, a history of previous abdominal surgery and the presence of a low cancer remained significant after multivariate analysis. The risk of anastomotic leakage increased when two or more risk factors were present (P < 0.01). The overall mortality was 3.7% and was higher in patients with anastomotic leakage (14.3%; P = 0.01). Conclusions: Male gender, previous abdominal surgery and low rectal cancer are associated with increased anastomotic leakage rates. These have important implications during preoperative patient counselling and decision-making regarding defunctioning stoma formation
Systematic review of the prevalence of faecal incontinence
No full textBackground Faecal incontinence (FI) is widely recognized as a significant problem in the community. Conjecture exists around the proportion of the population affected. This systematic review evaluated studies reporting the community prevalence of FI in terms of methodology, design and definitions. Methods MEDLINE, Embase, CINAHL, the Cochrane Collaboration and National Guideline databases were searched for studies investigating the prevalence of FI in community-based adults published from January 1966 to February 2015. Study data, including methodology, sample size, response rate, definition of FI and prevalence rates, were extracted on to a pro forma and appraised critically. Where possible, FI prevalence estimates were pooled. Results Thirty studies were analysed from 4840 screened articles. FI prevalence estimates varied from 1·4 to 19·5 per cent. This variation was explained by differences in data collection method and two factors within definitions of FI: type of stool and frequency of FI episodes. When these factors were accounted for, the FI prevalence at a threshold of at least once per month for liquid or solid stool was 8·3–8·4 per cent for face-to-face or telephone interviews, and 11·2–12·4 per cent for postal surveys. The pooled prevalence rate from studies for functional FI (defined by ROME II criteria) was 5·9 (95 per cent c.i. 5·6 to 6·3) per cent. Conclusion When comparable methodologies and definitions are used, studies produce remarkably similar prevalence rates in different community populations. FI remains an unspoken symptom, with lower rates reported in personal interviews compared with anonymous postal questionnaires.https://www.ncbi.nlm.nih.gov/pubmed/27704537VoR - Version of Recor
A criação de "Numa clara manhã de abril", de Marcos Iolovitch, no contexto histórico
No full textEste artigo procura inserir no contexto histórico o primeiro trabalho literário a usar a comunidade judaica brasileira como tema principal, o romance autobiográfico Numa clara manhã de abril, de Marcos Iolovitch, originalmente publicado em 1940. Iolovitch foi um imigrante que veio da Rússia no início do século XX para uma comunidade agrícola estabelecida pela Jewish Colonization Association (JCA ou ICA) na região sul do Brasil. Pretendemos discutir as condições sociais, culturais e econômicas tanto na Rússia quanto no Brasil, assim como as ações governamentais destes países durante o período 1801-1930, que contribuíram para a escrita deste romance e formaram o pano de fundo para os eventos e as ideias discutidas pelo autor. Nossa discussão inclui o estabelecimento de comunidades agrícolas judaicas na Rússia e o papel dos menonitas em sua administração, os esforços do Barão Maurice Hirsch e da ICA para estabelecer comunidades agrícolas para imigrantes russos, os motivos comerciais da ICA no Brasil, o efeito de convulsões políticas e econômicas no Brasil sobre os imigrantes judeus e o incentivo oferecido a escritores pela rica vida intelectual em Porto Alegre, a capital do estado do extremo sul do Brasil. Além das fontes secundárias, fundamentamos nossa discussão com memórias originais de menonitas e com relatórios e documentos do Departamento de Estado dos Estados Unidos da América das primeiras décadas do século XX. The Creation of On a clear April morning, by Marcos Iolovitch, in historical context - Abstract: This article seeks to place in historical context the first literary work to use the Brazilian Jewish community as subject matter, the autobiographical novel, On a Clear April Morning, by Marcos Iolovitch, originally published in 1940. Iolovitch was an early 20th century immigrant to the farming communities set up by the Jewish Colonization Association (JCA) in the south of Brazil. We propose to discuss social, cultural, and economic conditions in both Russia and Brazil, as well as governmental actions in both countries during the period 1801-1930 that led to the writing of this novel and formed the background for the events and ideas discussed by the author. Our discussion will include the establishment of Jewish farming communities in Russia and the role of Mennonites in their administration, the efforts by Baron Maurice Hirsch and the JCA to establish farming communities for Russian immigrants, the commercial motives of the JCA in Brazil, the effect of political and economic upheavals in Brazil on Jewish immigrants and the support offered to writers by the rich intellectual life in Porto Alegre, Brazil’s southernmost state capital. In addition to secondary sources, we will support our discussion with published interviews with Marcos Iolovitch, original Mennonite memoirs and early 20th Century U.S. Department of State reports and documents.
'Your connections to Nappamerrie is as strong as ours' : Pastoralism, Paternalism and the Legacies of Settlement
No full textThis thesis examines the relations between Aboriginal people and settlers on Nappa Merrie Station in far south-west Queensland. The station, established by John Conrick in 1873, remained in the author’s family for eighty-one years, with three generations of Conricks growing up there. A core focus is the written historical record and stories passed down by descendants, all of which place an emphasis on the Conrick family’s positive relations with, and conciliatory treatment of, Aboriginal people. This is especially significant given the notoriously violent interactions between Aboriginal people and pastoralists in Queensland. The author is the great-great-granddaughter of John Conrick, and this thesis follows the author’s journey to uncover the nature of the Conrick’s relations with Aboriginal people and analyse the veracity of the stories passed down through the generations. Additionally, the complex relationship and sense of belonging Conrick descendants have with Nappa Merrie and its Aboriginal population is examined. Using ‘insider’ knowledge, the author blends personal experience with academic historical training, connecting family history to the national story. A unique element of this thesis is the utilisation of the author’s rich family archive, which includes diaries, unpublished memoirs, letters, an extensive photograph and album collection, artefacts, and dictionaries of local languages. These are examined in conjunction with government records, newspaper articles, oral history transcripts and local historian Helen Tolcher’s books and research notes. While this thesis reveals the Conricks were more humane and conciliatory in their treatment of Aboriginal people in comparison to others at the time, it also reveals the enduring legacies of this history which continue today. This research demonstrates the veracity and selectivity of social memory and oral histories, through comparing family stories with historical records. The inconsistencies and absences in Conrick family narratives allow an insight into the influence of social norms and expectations on both individual and family memory over the decades. The thesis concludes with the recorded oral history of two Aboriginal Conrick descendants. This sharing of stories allows an insight into Aboriginal perspectives and contributes to the continuing legacies of Aboriginal and non-Aboriginal relations on Nappa Merrie Station.Thesis (MPhil) -- University of Adelaide, School of Humanities, 202
Design and validation of a comprehensive faecal incontinence questionnaire
No full textPURPOSE: Fecal incontinence can have a profound effect on quality of life. Its prevalence remains uncertain because of stigma, lack of consistent definition, and dearth of validated measures. This study was designed to develop a valid clinical and epidemiologic questionnaire, building on current literature and expertise. METHODS: Patients and experts undertook face validity testing. Construct validity, criterion validity, and test-retest reliability was undertaken. Construct validity comprised factor analysis and internal consistency of the quality of life scale. The validity of known groups was tested against 77 control subjects by using regression models. Questionnaire results were compared with a stool diary for criterion validity. Test-retest reliability was calculated from repeated questionnaire completion. RESULTS: The questionnaire achieved good face validity. It was completed by 104 patients. The quality of life scale had four underlying traits (factor analysis) and high internal consistency (overall Cronbach alpha=0.97). Patients and control subjects answered the questionnaire significantly differently (P<0.01) in known-groups validity testing. Criterion validity assessment found mean differences close to zero. Median reliability for the whole questionnaire was 0.79 (range, 0.35–1). CONCLUSIONS: This questionnaire compares favorably with other available instruments, although the interpretation of stool consistency requires further research. Its sensitivity to treatment still needs to be investigated
