149,602 research outputs found
Outpatient management of cancer-associated pulmonary embolism: A post-hoc analysis from the HOME-PE trial
No full textIntroduction: Cancer-related pulmonary embolism (PE) is associated with poor prognosis. Some decision rules identifying patients eligible for home treatment categorize cancer patients at high risk of complications, precluding home treatment. We sought to assess the effectiveness and the safety of outpatient management of patients with low-risk cancer-associated PE. Methods: In the HOME-PE trial, hemodynamically stable patients with symptomatic PE were randomized to either triaging with Hestia criteria or sPESI score. We analyzed 3 groups of low-risk PE patients: 47 with active cancer treated at home (group 1), 691 without active cancer treated at home (group 2), and 33 with active cancer as the only sPESI criterion qualifying them for hospitalization (group 3). The main outcome was the composite of recurrent venous thromboembolism, major bleeding, and all-cause death within 30 days after randomization. Results: Patients treated at home had composite outcome rates of 4.3 % (2/47) for those with cancer vs. 1.0 % (7/691) for those without (odds ratio (OR) 4.98, 95%CI 1.15–21.49). Patients with cancer had rates of complications of 4.3 % when treated at home vs. 3.0 % (1/33) when hospitalized (OR 1.19, 95%CI 0.15–9.47). In multivariable analysis, active cancer was associated with an increased risk of complications for patients treated at home (OR 7.95; 95%CI 1.48–42.82). For patients with active cancer, home treatment was not associated with the primary outcome (OR 1.19, 95%CI 0.15–9.74). Conclusions: Among patients treated at home, active cancer was a risk factor for complications, but among patients with active cancer, home treatment was not associated with adverse outcomes
Outpatient management of cancer-associated pulmonary embolism: A post-hoc analysis from the HOME-PE trial.
No full textpeer reviewedINTRODUCTION: Cancer-related pulmonary embolism (PE) is associated with poor prognosis. Some decision rules identifying patients eligible for home treatment categorize cancer patients at high risk of complications, precluding home treatment. We sought to assess the effectiveness and the safety of outpatient management of patients with low-risk cancer-associated PE. METHODS: In the HOME-PE trial, hemodynamically stable patients with symptomatic PE were randomized to either triaging with Hestia criteria or sPESI score. We analyzed 3 groups of low-risk PE patients: 47 with active cancer treated at home (group 1), 691 without active cancer treated at home (group 2), and 33 with active cancer as the only sPESI criterion qualifying them for hospitalization (group 3). The main outcome was the composite of recurrent venous thromboembolism, major bleeding, and all-cause death within 30 days after randomization. RESULTS: Patients treated at home had composite outcome rates of 4.3 % (2/47) for those with cancer vs. 1.0 % (7/691) for those without (odds ratio (OR) 4.98, 95%CI 1.15-21.49). Patients with cancer had rates of complications of 4.3 % when treated at home vs. 3.0 % (1/33) when hospitalized (OR 1.19, 95%CI 0.15-9.47). In multivariable analysis, active cancer was associated with an increased risk of complications for patients treated at home (OR 7.95; 95%CI 1.48-42.82). For patients with active cancer, home treatment was not associated with the primary outcome (OR 1.19, 95%CI 0.15-9.74). CONCLUSIONS: Among patients treated at home, active cancer was a risk factor for complications, but among patients with active cancer, home treatment was not associated with adverse outcomes
Sydney Area Transportation Study (SATS): Home Interview Survey, 1971
No full textThe objective of the Home Interview Survey (HIS) was to obtain information on the patterns and modes of travel by people living within the Sydney Study Area. Information was also collected about the characteristics of the people making the trips and their households. Three types of information were collected in the home interview survey: household data, person data, and trip data. The data are available in two separate files, a file of 'trip' records and a file of 'person' records. The household data is therefore repeated for each trip made by its members and person data is repeated for each trip made by that person. The Person Data File contains person data and household data for all persons interviewed in the selected homes. Each record of the Trip Data File contains the origin, destination, mode, purpose, parking and other trip information, as well as the person data for the person making the trip, and the household data for that person: number of card, type of housing, telephone in house, household size, family income, and changes in job location (head of household only). The household data is therefore repeated for each trip made by its members and person data is repeated for each trip made by that person. The Person Data File contains person data and household data for all persons interviewed in the selected homes. Backgournd variables include age, sex, occupation, employment sector, personal income, household income and employment status
The UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factors
No full textThe UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factor
Patients' Perspectives and Feasibility of Home Monitoring in Acute Care: The AcuteCare@Home Flash Mob Study
No full textObjective: To determine patients’ perspectives on home monitoring at emergency department (ED) presentation and shortly after admission and compare these with their physicians’ perspectives. Methods: Forty Dutch hospitals participated in this prospective flash mob study. Adult patients with acute medical conditions, treated by internal medicine specialties, presenting at the ED or admitted at the admission ward within the previous 24 h were included. The primary outcome was the proportion of patients who were able and willing to undergo home monitoring. Secondary outcomes included identifying barriers to home monitoring, patient’s prerequisites, and assessing the agreement between the perspectives of patients and treating physicians. Results: On February 2, 2023, in total 665 patients [median age 69 (interquartile range: 55–78) years; 95.5% community dwelling; 29.3% Modified Early Warning Score ‡3; 29.5% clinical frailty score ‡5] were included. In total, 19.6% of ED patients were admitted and 26% of ward patients preferred home monitoring as continuation of care. Guaranteed readmission (87.8%), ability to contact the hospital 24/7 (77.3%), and a family caregiver at home (55.7%) were the most often reported prerequisites. Barriers for home monitoring were feeling too severely ill (78.8%) and inability to receive the required treatment at home (64.4%). The agreement between patients and physicians was fair (Cohens kappa coefficient 0.26). Conclusions: A substantial proportion of acutely ill patients stated that they were willing and able to be monitored at home. Guaranteed readmission, availability of a treatment team (24/7), and a home support system are needed for successful implementation of home monitoring in acute care
A socio-ecological approach to understanding adolescent girls' engagement and experiences in the PE environment : a case study design
No full textAdolescence is known to be a period of increased risk for the development of unhealthy behaviours such as physical inactivity (Currie et al., 2011). Low physical activity (PA) levels are especially noted in girls, who typically engage in less PA than boys throughout the teenage years (Whitehead and Biddle 2008). In Scotland, evidence suggests there is a significant decline in PA among adolescent girls, with only 41% of 13−15 year olds achieving the current recommendations, compared with 56% of 11−12 year olds (Scottish Executive, 2011). In addition, a proportion of girls are not engaging with school PE classes (Niven et al., 2014; Kirby et al., 2012). In order to understand more about how and why this decline exists, a sample of 20 ‘disengaged’ 12−13-year-old girls (second year of secondary school) were recruited from four case study schools in Scotland. This study aims to explore the interaction between the social and physical environment, and how these affect disengaged girls’ experiences and engagement in PE. Girls were categorised as ‘disengaged’ from PE if they did not participate regularly and reported negative emotions about the subject. Girls took part in in-depth interviews to explore their experiences and engagement in PE. The theoretical framework is based on Welks (1999) Youth Physical Activity Promotion model (YPAP), a socio-ecological approach which conceptualises the influential correlates of PA as: individual-level predisposing and enabling factors, including personal attributes and environmental variables and reinforcing (social) factors. This model was applied within a Scottish education context to understand the importance of each component and also the interaction between these and the influence that one may have on another. The results indicate that although the type of activity offered in PE is important, it appears that perceptions of competence and the social environment these were delivered in, such as single-sex classes, had more of an influence on girls’ engagement in PE. For this group of Scottish adolescent girls, the wider psychosocial environment in which PE takes place may have a greater impact on levels of enjoyment and participation than the PA itself.Peer reviewe
Residual disability and psychosocial status after Guillain Barré syndrome: a 3 to 5 year follow-up study
No full textGuillain-Barré syndrome (GBS) is the most common cause of acute not-traumatic neuromuscular paralysis. Even if the disease usually has a good prognosis, recovery is not always complete and residual motor or sensory signs may remain. Little is known on the incidence of disability and long term psychosocial status in GBS. We present the results of a 3 to 5 year follow-up study of the residual signs, including fatigue, pain and psychosocial status in 75 GBS patients, aged from 20–82 years (mean 56). The functional grading at the onset and at the follow up was performed using the Hughes scale and the data about residual symptoms were obtained at the follow up by phone interview. Among the 56 patients interviewed, 44 (78%) were asymptomatic or had minimal signs of neuropathy (0–1 grade of Hughes scale), 7 (13%) remained moderately disabled (grade 2), 4 (7%) were unable to walk independently (grade 3), and one patient died. 51 (92%) were able to live independently at home while only 3 (5%) needed continuous or partial assistance. 33% of patients (18) reported fatigue in all their activities while 27% (15) had residual pain, which rarely caused restriction in daily living. 23% of patients (13) changed or temporarily or definitively suspended their job. 59% reached the maximum improvement in the first year while 21% continued to improve in the three following years. We observed that patients>40 years old were more severely impaired than the younger ones (76% vs 60% of patients had grade 4 or 5 of Hughes scale) while permanent disability was only observed in those aged>60 years (14% of patients vs none of the younger patients had grade 3). No difference was found in the outcome between patients with or without assisted ventilation. Patients reaching maximal worsening within 10 days achieved maximal improvement more quickly and remained less disabled than the others while those with>10 days plateau duration remained more severely impaired than those with a shorter duratio
Unlocking higher education spaces - what might mathematics tell us?
No full textBackground: this three day virtual study group aimed to try to help unlock higher education in the UK following the lockdown.Universities and the knowledge they create have been vital in the fight against the COVID19 pandemic; we have seen innovation coming from the academic base inform policy in modelling pandemics, develop track and trace capability and carry out fundamental work in clinical trials for a vaccine to name but a few contributions. In addition, universities support economic growth in their regions through direct employment and the many services and outlets connected to them.However, universities are suffering in the face of the pandemic with campuses largely closed, physical teaching courses suspended and many staff furloughed. The vibrant ecosystems that are UK universities, combine teaching, research and social activities and consequently opening them back up to normal operation will pose significant challenges including among others:access and flow of people through buildings,shared surfaces and bathrooms,potential for aerosol transmission in indoor spaces,operation of food outlets,operation of leisure facilities,interaction between the university, the wider local community, and home communities of students and staff,interaction with public transport.The challenge of opening universities back to closer to normal operation can be seen as a complex, multi-level problem where challenges exist on a building level, a campus level, and a community level. The Virtual Forum for Knowledge Exchange in the Mathematical Sciences (V-KEMS) was set up to help solve Covid-19 related problems. We have pioneered a successful virtual format for study groups, a proven mechanism that brings academic mathematicians together with problem holders in industry and the public sector to address real-world challenges through collaborative modelling.Aims and Objectives: the study group focused on applying mathematical tools and models to various issues linked to these complex challenges. Around 40 researchers and end-users were assembled to discuss, and provide potential avenues of exploration for opening up universities.Previous work through V-KEMS discussed general mathematical principles which could be considered when unlocking the workforce, and to a certain extent, this problem built on that foundation of knowledge with an application to university operation. In particular, we were interested in understanding: How much would grouping students into bubbles based on geography (halls of residence, residential streets) and using these to organise access to campus reduce transmission of disease compared to allowing everyone on at the same time? Can students access social activities within their bubbles as well as academic ones?What can we say about the benefits of bubbles and / or a less densely occupied campus?How small would bubbles need to be to make a difference and consequently how much time would students be able to spend on campus?How much could bubbles facilitate control of transmission through test, trace and isolate?How might some general principles apply to professional services and facilities staff such cleaners and security staff to reduce transmission on campus?What about transport to and from campus? How might one manage the interaction with local transportation routes? What can we say about the transmission of infection between a university, its local community and the wider home communities of staff and students?Over the three days, teams developed a list of topics in consultation with end-users. Once the main considerations had been established, these were built into model development. Such model building included for instance, Bayesian belief networks, agent-based modelling, bubble scheduling. Time was also given to developing strategies for effectively communicating models and model assumptions to the end users.As this was a multifaceted challenge with many players, we were very keen to engage broadly across those relevant parties. There were diversity and inclusion considerations we needed to capture in the conversation. As such, we were delighted to have representation from COO's of universities, estates and services professionals and a Student Union representative.We were particularly interested to engage with university representatives who were able to provide data on relevant aspects of university life, for example - building layouts and capacities- timetables- accommodation statistic
Red blood cell count in short-term prediction of cardiovascular disease incidence in the Gubbio population study.
No full textAssociation between SARS-CoV-2 Seroprevalence in Nursing Home Staff and Resident COVID-19 Cases and Mortality: A Cross-Sectional Study
No full textThe burden of COVID-19 has disproportionately impacted the elderly, who are at increased risk of severe disease, hospitalization, and death. This cross-sectional study aimed to assess the association between SARS-CoV-2 seroprevalence among nursing home staff, and cumulative incidence rates of COVID-19 cases, hospitalizations, and deaths among residents. Staff seroprevalence was estimated within the SEROCoV-WORK+ study between May and September 2020 across 29 nursing homes in Geneva, Switzerland. Data on nursing home residents were obtained from the canton of Geneva for the period between March and August 2020. Associations were assessed using Spearman’s correlation coefficient and quasi-Poisson regression models. Overall, seroprevalence among staff ranged between 0 and 31.4%, with a median of 8.3%. A positive association was found between staff seroprevalence and resident cumulative incidence of COVID-19 cases (correlation coefficient R = 0.72, 95%CI 0.45–0.87; incidence rate ratio [IRR] = 1.10, 95%CI 1.07–1.17), hospitalizations (R = 0.59, 95%CI 0.25–0.80; IRR = 1.09, 95%CI 1.05–1.13), and deaths (R = 0.71, 95%CI 0.44–0.86; IRR = 1.12, 95%CI 1.07–1.18). Our results suggest that SARS-CoV-2 transmission between staff and residents may contribute to the spread of the virus within nursing homes. Awareness among nursing home professionals of their likely role in the spread of SARS-CoV-2 has the potential to increase vaccination coverage and prevent unnecessary deaths due to COVID-19
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