21 research outputs found
Editor's choice : European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on antithrombotic therapy for vascular diseases
No full textThe European Society for Vascular Surgery (ESVS) has developed a series of clinical practice guidelines for clinicians caring for patients with vascular diseases. This is the first guideline specifically examining antithrombotic therapy. The aim of the guideline is to assist clinicians and patients in selecting an optimal antithrombotic strategy.</p
Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms.
No full textpeer reviewedOBJECTIVE: The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS: The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS: A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION: The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms
Editor's choice : European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on antithrombotic therapy for vascular diseases
No full textA
Prevention of RhD alloimmunization in Northern British Columbia
No full textDespite best practice guidelines, international evidence suggests that the provision of anti-D prophylaxis to RhD negative pregnant women is suboptimal. Missing from the literature is research exploring the factors that perpetuate suboptimal care and continue to put RhD negative pregnant women at risk for RhD alloimmunization. The purpose of this study was to understand why RhD negative pregnant women continue to be at risk for RhD alloimmunization in northern BC. The specific research questions were: How do healthcare providers make decisions regarding the care of RhD negative pregnancies in northern BC? How do RhD negative women in northern BC experience pregnancy?
A qualitative approach utilizing interpretive description was used to address the need for the development of rural centric clinical guidelines. Interviews were conducted with RhD negative women about pregnancy and healthcare providers’ experiences in caring for RhD negative pregnancies in northern BC. A Stakeholder Committee guided the research process and provided insight into data analysis to ensure applicability to practice. A qualitative approach with these two populations has provided a greater understanding into the depth of quality of care for RhD negative pregnancies and the decisions that inform patient safety by revealing nuances of care that lead to potential miscommunication and near misses. Recommendations into guideline adaptation, decision-making and health literacy in rural healthcare settings are presented.RhD alloimmunizationRhD negativepregnant womenrural healthcar
Do UK based weight management programmes cause weight loss maintenance in adults? A systematic review
No full textThe aim of this dissertation was to examine whether UK based weight management programmes promote weight loss maintenance (follow up of 12 months to assess effectiveness of intervention in weight loss) in adults through the process of a systematic review. The World Health Organisation (WHO) has described obesity as a "global epidemic". Weight management comprises two phases; weight loss and weight loss maintenance. The latter phase is the true goal for obesity and the most difficult element of weight management to achieve. However much less is know about this as compared with the weight loss phase. There is little purpose in committing time and money to reducing obesity if the weight is regained. This is counter-productive and weight loss maintenance is essential to combat the obesity epidemic. Searches were made for relevant information from a variety of scientific online databases and journals,. Seven articles met the inclusion criteria and were analysed in the review. All studies incorporated a multi-component (diet, exercise, behaviur modification) intervention approach. All control and internvetion groups reported weight loss at 12 months when compared with baseline. All groups recieved an intervention. One study reported a significant difference (P<0.05) between groups. Four studies reported on at least one component (diet, physical activity, behaviour modification) however there was not enough information to conclude whether they complied with national guidelines (NICE CG43 and SIGN 115). High attrition rates and loss to follow up are problematic for each study except one. Analysis on an intention to treat basis was common however this is problematic and there are alternative methods which may be more suitable for dealing with missing data
Gap Analysis towards A Design Qualification Standard Development for Grid-Connected Photovoltaic Inverters
No full textabstract: The high penetration of photovoltaic (PV) both at the utility and at the distribu-tion levels, has raised concerns about the reliability of grid-tied inverters of PV power systems. Inverters are generally considered as the weak link in PV power systems. The lack of a dedicated qualification/reliability standard for PV inverters is a main barrier in realizing higher level of confidence in reliability. Development of a well-accepted design qualification standard specifically for PV inverters will help pave the way for significant improvement in reliability and performance of inverters across the entire industry. The existing standards for PV inverters such as UL 1741 and IEC 62109-1 primarily focus on safety. IEC 62093 discusses inverter qualification but it includes all the balance of sys-tem components and therefore not specific to PV inverters. There are other general stan-dards for distributed generators including the IEEE1547 series of standards which cover major concerns like utility integration but they are not dedicated to PV inverters and are not written from a design qualification point of view. In this thesis, some of the potential requirements for a design qualification standard for PV inverters are addressed. The IEC 62093 is considered as a guideline and the possible inclusions in the framework for a dedicated design qualification standard of PV inverter are discussed. The missing links in existing PV inverter related standards are identified by performing gap analysis. Dif-ferent requirements of small residential inverters compared to large utility-scale systems, and the emerging requirements on grid support features are also considered. Electric stress test is found to be the key missing link and one of the electric stress tests, the surge withstand test is studied in detail. The use of the existing standards for surge withstand test of residential scale PV inverters is investigated and a method to suitably adopt these standards is proposed. The proposed method is studied analytically and verified using simulation. A design criterion for choosing the switch ratings of the inverter that can per-form reliably under the surge environment is derived.Dissertation/ThesisM.S. Electrical Engineering 201
Topics of the Tenth Session of the Intergovernmental Committee for the Safeguarding of the Intangible Cultural Heritage and Issues Raised through Discussions
No full textThe tenth session of the Intergovernmental Committee for the Safeguarding of the Intangible Cultural Heritage was held from 30 November to 4 December, 2015 in Windhoek, Namibia. During the session, 23 elements of intangible cultural heritage were inscribed on the Representative List of the Intangible Cultural Heritage of Humanity (Representative List). This year, there was no element nominated from Japan for inscription. The number of elements for discussion each year is limited to 50, and over-represented countries such as Japan could not have their nomination files evaluated even though they were submitted.
From this session, a single body named the Evaluation Body evaluated the nominations to the Urgent Safeguarding List and the Representative List, proposals to the Register of Best Safeguarding Practices, and requests for International Assistance greater than US$25,000 instead of the former Subsidiary Body and Consultative Body. Because the body is comprised of experts from the States Parties other than the Committee Members and accredited NGOs, credibility and transparency of the evaluation process of the files seemed to have improved from those of the former Subsidiary Body whose members were chosen from the Committee Members. The Evaluation Body reported that it could evaluate the files of all mechanisms with the same standard. The re-defined referral and not-to-inscribe options were also applied for the first time to the evaluation of nomination files to the Representative List. There was only one element recommended ‘not to be inscribed’ on the List; in contrast the number of the files recommended to be referred back to the States Parties was increased from 6 at the last session to 15.
As for the quality of the nomination files, the Evaluation Body pointed out that sometimes information was missing, incorrect, or misplaced. The body also suggested that the Secretariat provide a guideline for establishing inventories of intangible cultural heritage. There were opinions at the Committee that it is difficult to compile a manual on how to develop inventories since the cultural contexts of the States Parties vary. However, the author considers that there are some attributes essential for an inventory, such as the name of the element, place or communities to practice the element. On the other hand, classification that is understandable internationally should be developed, considering the characteristics of the elements practiced in the different context of each State Party. The author thinks that this kind of classification should be made by experts who are highly knowledgeable about intangible cultural heritage and that such exercise could be a good item of international support by Japanese experts.departmental bulletin pape
Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening
No full textBACKGROUND:
The English NHS Diabetic Eye Screening Programme was established in 2003. Eligible people are invited annually for digital retinal photography screening. Those found to have potentially sight-threatening diabetic retinopathy (STDR) are referred to surveillance clinics or to Hospital Eye Services.
OBJECTIVES:
To determine whether personalised screening intervals are cost-effective.
DESIGN:
Risk factors were identified in Gloucestershire, UK using survival modelling. A probabilistic decision hidden (unobserved) Markov model with a misgrading matrix was developed. This informed estimation of lifetime costs and quality-adjusted life-years (QALYs) in patients without STDR. Two personalised risk stratification models were employed: two screening episodes (SEs) (low, medium or high risk) or one SE with clinical information (low, medium-low, medium-high or high risk). The risk factor models were validated in other populations.
SETTING:
Gloucestershire, Nottinghamshire, South London and East Anglia (all UK).
PARTICIPANTS:
People with diabetes in Gloucestershire with risk stratification model validation using data from Nottinghamshire, South London and East Anglia.
MAIN OUTCOME MEASURES:
Personalised risk-based algorithm for screening interval; cost-effectiveness of different screening intervals.
RESULTS:
Data were obtained in Gloucestershire from 12,790 people with diabetes with known risk factors to derive the risk estimation models, from 15,877 people to inform the uptake of screening and from 17,043 people to inform the health-care resource-usage costs. Two stratification models were developed: one using only results from previous screening events and one using previous screening and some commonly available GP data. Both models were capable of differentiating groups at low and high risk of development of STDR. The rate of progression to STDR was 5 per 1000 person-years (PYs) in the lowest decile of risk and 75 per 1000 PYs in the highest decile. In the absence of personalised risk stratification, the most cost-effective screening interval was to screen all patients every 3 years, with a 46% probability of this being cost-effective at a £30,000 per QALY threshold. Using either risk stratification models, screening patients at low risk every 5 years was the most cost-effective option, with a probability of 99-100% at a £30,000 per QALY threshold. For the medium-risk groups screening every 3 years had a probability of 43-48% while screening high-risk groups every 2 years was cost-effective with a probability of 55-59%.
CONCLUSIONS:
The study found that annual screening of all patients for STDR was not cost-effective. Screening this entire cohort every 3 years was most likely to be cost-effective. When personalised intervals are applied, screening those in our low-risk groups every 5 years was found to be cost-effective. Screening high-risk groups every 2 years further improved the cost-effectiveness of the programme. There was considerable uncertainty in the estimated incremental costs and in the incremental QALYs, particularly with regard to implications of an increasing proportion of maculopathy cases receiving intravitreal injection rather than laser treatment. Future work should focus on improving the understanding of risk, validating in further populations and investigating quality issues in imaging and assessment including the potential for automated image grading
The safety and effectiveness of different methods of ear wax removal: a systematic review and economic evaluation
No full textEar wax (cerumen) is a natural secretion produced to protect the inner ear from dirt and other fragments by moving these particles towards the outer ear. If this process does not happen properly, wax may build up causing blockage in the ear canal and the possibility of impaction. People with a build up of ear wax may suffer from hearing loss, discomfort and, on occasions, infection. It may present problems in assessing hearing, blocking the view of the ear drum during medical examination and interfering with the fitting or function of hearing aids. Although it is thought to affect between 2% and 6% of the population in the England and Wales, some groups may be at a higher risk, such as those using hearing aids or with small ear canals and/or skin conditions. Recurrence is thought to be high among some of these groups. The consequences of the build up of ear wax in the ear canal are thought to be a common reason for consultation and cost in general practice with over 2 million consultations per year in the NHS.Methods of removal of ear wax include drops, flushing with water in general practice, and removal with suction or probes in specialist clinics. The relative safety and benefits of these different methods of removal remains uncertain. This research will systematically review published and unpublished evidence on the clinical and cost effectiveness of different methods for the removal of ear wax. Where appropriate, it will develop an economic model using data from this systematic review and other relevant sources to estimate the relative costs and benefits of different methods. In addition, the project will provide recommendations for future research to try to help answer any remaining areas of uncertainty
Attention deficit hyperactivity disorder (ADHD) within a South Indian (Keralian) mainstream school context
No full textAttention Deficit Hyperactivity Disorder (ADHD) is a widely discussed special educational issue in Western contexts and developed countries. By contrast, limited information is available about ADHD in Eastern contexts and developing countries. In India in particular, the only available information is about the medical perspective of ADHD; little or no attention is given to social or educational perspectives. DSM IV criteria are the most commonly used standard assessment procedures. However, limited research is reported to discuss the potential cultural influences of this North American model. The present study examines the incidence and interpretation of ADHD within the context of five mainstream schools in Trivandrum, South India. It also explored cultural influences impact upon the cultural validity and reliability of DSM IV criteria when introduced into a South Indian context. In order to identify children with ADHD characteristics, culturally valid assessment tools such as behaviour checklist and behaviour rating scales, were developed from DSM IV (TR) symptoms criteria. Qualitative data was gathered from the five sample schools during the academic year of 2006-07 using a variety of methods including in-depth interviews (with 21 teachers), classroom observations (of 26 children), rating scale and document scrutiny. The case study method was adopted to gain in-depth information about the identified children. Informal interviews with parents (24) were also utilised to triangulate the information gathered from the school contexts. Qualitative data analysis techniques such as open coding and case analysis were used to assess children's behavioural characteristics and difficulties. The findings indicate that three percent of children (21) had ADHD characteristics within the sample schools. Some of the findings are consistent with the studies reported in Western contexts. There are also some contrasting results: a) most of the identified children had inattention rather than hyperactivity characteristics, b) a higher number of children with ADHD characteristics were from lower socio-economic backgrounds, c) teachers used coercive methods of physical punishments and sanctions as they interpreted the children's ADHD characteristics as a result of their lack of interest in learning. Most importantly, though DSM IV (TR) criteria are useful in identifying ADHD, two items of the 'symptoms' criteria were not identifiable within the present context of the sample schools. The findings suggest that socio-cultural factors do influence the validity and reliability of DSM IV criteria. The study has implications not only for further research but also for planning and policy making in the field of education for all. The conclusions suggest that an educational provision should be considered with regards to the varied and complex needs of children with special educational needs such as ADHD. Teacher education programmes should be enhanced with positive intervention strategies
