1,721,629 research outputs found
The development of clinical prediction guides requires reproducible decision-making outputs: a field study
No full textBackground. The decisions taken by occupational physicians (OPs) generally show low reproducibility and reflect some uncertainties linked to the decision making process.Aim. The aim of the study was to evaluate the variability of different OP decisions in order to assess their reproducibility, which is regarded as a quality factor of the professional practice.Methods. 4 OPs examined the records of 100 selected hospital workers with impaired health conditions in order to take decisions about job fitness, advice to workers, referral to clinical physician, need for further investigations, report of occupational disease and recommendation for the general practitioner. The variability of inter-individual decision was measured by percent agreement and Cohen’s kappa test.Results. After accounting for variability expected by chance, the agreement among decisions on job fitness ranged from fair to substantial, but high variability was observed for most other assessments.Conclusion. The observed inter-individual variability for some decisions taken by different OPs represents a crucial aspect to be dealt with, because the reproducibility of medical decisions is an indispensable requirement for the derivation of clinical prediction guides to be built and adopted for improving the practice
A Numerical Scheme for Integrating the Rate Plasticity Equations with an "A Priori" Error Control
No full textA stable/neutral equilibrium path for the numerical solution of elastic-plastic softening problems
No full textCommento sub artt. 3, 5, 9, 106, 107, 122, 125, 126, 127, 128, 140, 142, 143, 147, 150, 286, 287, 292 d.lgs. 7 settembre 2005, n. 209
No full textCommento alla disciplina contenuta nel codice delle assicurazioni privat
Evidence-based decision making in an endoscopy nurse with respiratory symptoms exposed to the new ortho-phthalaldehyde (OPA) disinfectant
No full textBackground ortho-Phthalaldehyde (OPA) can cause mucous irritation, respiratory symptoms and IgE-mediated hypersensitivity reactions. Very little information is available about OPA-related effects in health personnel. Aim To report the decision-making process for the case of an endoscopy nurse complaining of cough and burning of the nose and throat during OPA exposure at work. Methods The problem focused on the relationship between OPA exposure and the respiratory symptoms and was investigated using an evidence-based (EB) medicine paradigm. Results A literature search was performed using the database Medline and the search engine Google (TM). Papers and guidelines were assessed for their suitability in the EB case identification of suspected occupational asthma (OA). A multistep approach suggested by a guideline was considered most appropriate for practical use. The nurse shared the decision-making process and underwent evaluation of the clinical suspicion index and interventions for diagnosis of OA. Despite the high clinical suspicion index, the diagnosis of OA was excluded and any work restriction was avoided. Health surveillance follow-up showed a good clinical outcome and prompt recovery from respiratory symptoms after improvement of environmental control measures. Conclusion The case study shows that the implementation of EB guidelines provides the occupational physician with an appropriate decision-making process for the identification and management of workers with suspected OA. Screening out of OA is highly relevant because diagnosis of disease requires removal from exposure and frequently impacts negatively on worker employment
Undifferentiated and dedifferentiated head and neck carcinomas
No full textUndifferentiated carcinomas arising at salivary gland and head and neck mucosal sites may originate either de novo or through a process of dedifferentiation of a differentiated carcinoma. While in the latter group the diagnosis is largely dependent on the identification of the differentiated component or recognition of a specific genotype, the classification of undifferentiated carcinomas that lack a differentiated component is mainly based on the identification of specific genetic drivers, like for example the NUTM1 fusions in NUT carcinoma. A further category is represented by virus associated carcinomas (mainly HPV and EBV), that frequently displays an undifferentiated morphology. Overall, these tumors often represent a diagnostic challenge, especially in small biopsies. This review summarizes and discuss the diagnostic approach to the main head and neck carcinoma types that frequently or occasionally display an undifferentiated appearance, with a focus on salivary gland, oropharyngeal, nasopharyngeal and sinonasal subsites
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