287,112 research outputs found
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
The significance of isolated de novo red patches in the bladder in patients referred with suspected urinary tract cancer : Results from the IDENTIFY study
No full textPublisher Copyright: © 2024 The Author(s). BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.Objectives: To assess the contemporary malignancy rate in isolated de novo red patches in the bladder and associated risk factors for better selection of red patch biopsy. Patients: Patients from the IDENTIFY dataset; Patients referred to secondary care with suspected urinary tract cancer and found to have isolated de novo red patches on cystoscopy. Methods: We reported the unadjusted cancer prevalence in isolated de novo red patches that were biopsied; multivariable logistic regression was used to explore cancer-associated risk factors including age, sex, smoking, type of haematuria, LUTS, UTIs and a suspicious-looking red patch (as reported by the cystoscopist). Sub-analysis of these by clinical role and experience was performed. Results: A total of 1110 patients with isolated de novo red patches were included. 41.5% (n = 461) were biopsied, with a malignancy rate of 12.8% (59/461), which was significantly higher in suspicious versus non-suspicious red patches (19.1% vs. 2.81%, p < 0.01). There was a significant association between bladder cancer and age (OR 1.04, 95% CI 1.01–1.07, p = 0.01), smoking history (OR 2.62, 95% CI 1.09–6.27, p = 0.03) and suspicious-looking patch (OR 6.50, 95% CI 2.47–17.1, p < 0.01). The majority of malignancies were in over 60-year-olds. Malignancy rates in suspicious versus non-suspicious red patches did not differ significantly between clinical roles or experiences. Limitations included subjectivity in classifying a suspicious patch and selection bias as not all patches were biopsied. Conclusions: Many patients still undergo unnecessary biopsies under general anaesthetic for isolated de novo red patches. Clinicians should consider the patient's age, smoking status and how suspicious-looking the patch is, before deciding on surveillance versus biopsy to improve cancer diagnostic yield.Peer reviewe
Evaluation of clinical examination and preoperative imaging in patients with right iliac fossa pain and a medium or high risk score for appendicitis (RIFT-2)
No full textIntroduction: Clinical risk models can be used to identify UK patients with right iliac fosa
pain who are at low-risk of appendicitis and can be safely managed on ambulatory pathways,
avoiding hospital admission and unnecessary surgery. This study examined the diagnostic
pathways in patients with medium or high-risk scores.
Methods: This prospective cohort study included patients admitted with suspected
appendicitis in the UK. Patients aged ≥16 years were included if they had a medium or
high-risk score for appendicitis (Appendicitis Inflammatory Response Score (AIRS) >2 in
men, Adult Appendicitis Score (AAS) >8 in women). The primary outcome measure was
the normal appendicectomy rate (NAR). The AIRS and AAS risk prediction models were
validated against pre-determined criteria.
Results: This UK study included 2,231 women and 1,958 men. Overall, 57.7% of patients
underwent surgery. The NAR was 18.4% in women aged 16-45 years, 9.5% in men aged 16-
45 years, 4.5% in women aged ≥46 years, and 2.1% in men aged ≥46 years. Risk prediction
models did not achieve the pre-determined threshold to be used to identify patients with
appendicitis. Ultrasound was the most common imaging modality in women aged 16-45
years, whereas CT was most common in the other subgroups. CT was performed in 12.8%
of women aged 16-45 years, 21.1% in men aged 16-45 years, 69.3% in women aged ≥46
years, and 74.5% in men aged ≥46 years. The overall NAR in patients who had CT imaging
alone (3.6%) was lower than in patients who had no imaging (12.4%) or ultrasound imaging
alone (19.0%).
Conclusion: UK patients with a low-risk of appendicitis should be triaged to ambulatory
management, whilst those with a medium/high-risk should mostly undergo a CT scan.
Normal appendicectomy should become a specific therapeutic option rather than a chance
finding
Healthcare professionals’ perceptions of Type 2 Diabetes Mellitus care in the Mediterranean Region
No full textIntroduction:
This study aimed to assess the adherence to guidelines by practitioners working in the Mediterranean region and to identify the reasons for non-compliance.Methods:
A opportunistic self-administered questionnaire was circulated among members of the Mediterranean Group for the Study of Diabetes (MGSD) and regional diabetic associations. The study was limited to the Mediterranean region; 2841 medical practitioners participated in the study. Intervention involved a self-administered questionnaire enabling demographic and personal details to be correlated to relevant information related to practice and continuing health professional education (CHPE) attitudes, perceptions related to diabetes and healthcare systems in the community, and physicians’ attitudes to healthcare practices and target goals relevant to type 2 diabetes mellitus (T2DM). The main outcome measure was adherence to evidence-based guidelines.Results:
While the majority of respondents (69.9%) reported being confident in managing these patients, and 79.2% reported being aware of the availability of local guidelines; only a fifth opted to manage patients by strictly targeting an HbA1c value below 6.5%, while 3.3% were happy to maintain an HbA1c value of up to 8.0%. These goals appeared to be tempered by fear of eliciting hypoglycaemia in the belief that patients and their families do not have the skills to manage the complication. Endocrinologists/internists preferred more rigid control.Conclusion:
It is clear that the promulgation of evidence-based guidelines cannot assume automatic adoption in clinical practice since adoption is tempered by on-the-ground practice circumstances that make the practitioner reluctant to fully endorse and adopt the targets defined by the guidelines. The evidence-based guidelines need to be modified for local or regional circumstances.This study and the Rapid Service Fee were supported by a financial grant from the Mediterranean Group for the Study of Diabetes which is supported by an unrestricted educational grant from Servier.peer-reviewe
Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identification of risk factors
No full textAims to identify risk factors and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery based on analysis of the findings of the European Society of Cataract and Refractive Surgeons (ESCRS) multicenter study. Setting: Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom. A prospective randomized partially masked multicenter cataract surgery study recruited 16 603 patients. The study was based on a 2 × 2 factorial design, with intracameral cefuroxime and topical perioperative levofloxacin factors resulting in 4 treatment groups. The comparison of case and non-case data was performed using multivariable logistic regression analyses. Odds ratios (ORs) associated with treatment effects and other risk factors were estimated. Twenty-nine patients presented with endophthalmitis, of whom 20 were classified as having proven infective endophthalmitis. The absence of an intracameral cefuroxime prophylactic regimen at 1 mg in 0.1 mL normal saline was associated with a 4.92-fold increase (95% confidence interval [CI], 1.87-12.9) in the risk for total postoperative endophthalmitis. In addition, the use of clear corneal incisions (CCIs) compared to scleral tunnels was associated with a 5.88-fold increase (95% CI, 1.34-25.9) in risk and the use of silicone intraocular lens (IOL) optic material compared to acrylic with a 3.13-fold increase (95% CI, 1.47-6.67). The presence of surgical complications increased the risk for total endophthalmitis 4.95-fold (95% CI, 1.68-14.6), and more experienced surgeons were more likely to be associated with endophthalmitis cases. When considering only proven infective endophthalmitis cases, the absence of cefuroxime and the use of silicone IOL optic material were significantly associated with an increased risk, and there was evidence that men were more predisposed to infection (OR, 2.70; 95% CI, 1.07-6.8). Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis. Additional risk factors associated with endophthalmitis after cataract surgery included CCIs and the use of silicone IOLs
Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children.
No full textObjective: To determine whether using a combination of body mass index (BMI) and waist circumference (WC) or waist-to-height ratio (W/Hr) is clinically helpful in identifying children with high metabolic and cardiovascular risks. Study design: Caucasian children (M/F: 740/739; n = 1479; ages 5 to 15 years) were studied. Anthropometry, blood pressure, and venous fasting blood samples tested for triacylglycerol, HDL cholesterol, and glucose were measured. Results: Overweight children with a large waist (>90th percentile) or high W/Hr (>0.5) but not obese or normal-weight children had significantly greater chances of being at high metabolic and cardiovascular risk than normal-weight children (OR: 7; 95% CI: 3.63-13.48; P < .001, OR: 8.16; 95% CI: 3.87-17.23; P < .001, respectively) with a low waist measurement (≤90th percentile) or W/Hr (≤0.5). Interestingly, waist and W/Hr cutoffs (90th percentile and 0.5, respectively) were both able to identify children with the highest metabolic and cardiovascular risks among those who were overweight. However, contrary to waist circumference, W/Hr has the advantage of not requiring population specific reference tables as well as age and sex specific cutoffs. Conclusions: Waist circumference and W/Hr are helpful in detecting, among overweight children, those with a higher likelihood of having metabolic and cardiovascular risks
The prognosis and main prognostic indicators of Guillain-Barré syndrome. A multicentre prospective study of 297 patients
No full textTo assess the prognosis of the Guillain-Barré syndrome and identify the main prognostic indicators, 297 patients with Guillain-Barré syndrome recruited through a network of Italian centres were followed up for 24 months or until clinical recovery, whichever was earliest. For each patient the time to plateau, improvement, clinical recovery, or death was calculated, and prognostic indicators (age, sex, antecedent events, disability at admission and nadir, electrophysiological patterns) and treatments were noted. The mean duration of follow-up was 309 days. During this period, 212 patients (71%) recovered, 48 (16%) had residua and 33 (11%) died. The mean times to nadir, improvement and clinical recovery were 12, 28 and 200 days. Using life-tables and survival curves, the cumulative probability of achieving the plateau of symptoms was 73% by 1 week and 98% by 4 weeks. Improvement started during the first week in 36% of cases and within 4 weeks in 85%. The rates of clinical recovery at 1 and 4 weeks, 6, 12 and 24 months were 4, 24, 57, 70 and 82%, respectively. The chance of recovery was significantly affected by age, antecedent gastroenteritis, disability, electrophysiological signs of axonopathy, latency to nadir and duration of active disease. The main treatments did not seem to affect the chance of recovery
High GADA titer increases the risk of insulin requirement in LADA patients: a 7-year follow-up (NIRAD study 7).
No full textThe aim of this study was to determine whether glutamic acid decarboxylase antibody (GADA) titer and other clinical parameters could define the risk of progression to insulin therapy in latent autoimmune diabetes in adults (LADA) patients during a 7-year follow-up.
This study involved 220 LADA and 430 type 2 diabetes subjects followed up for 7 years from the time of GADA screening to evaluate their progression toward insulin therapy. Kaplan-Meier curves and multivariate logistic regression analysis were performed to identify the markers capable of influencing this progression.
RESULTS:
During the follow-up, the drop out was 4% in both groups. A total of 119 (56.1%) out of 212 LADA patients required insulin during the 7 years of follow-up. The Kaplan-Meier plots showed that 74/104 (71.1%) of high GADA titer required insulin compared with 45/108 (41.6%) of low GADA titer and with 86/412 (20.9%) of type 2 diabetes (P<0.0001 for both). A BMI of ???25???kg/m2 and IA-2IC and zinc transporter 8 (ZnT8) positivity were also shown as the markers of faster progression (P<0.0001 for both). The proportion of LADA patients requiring insulin was significantly higher in the group of subjects treated also with sulfonylurea in the first year from diagnosis compared with those treated with diet and/or insulin sensitizers (P<0.001). The multivariate analysis confirmed that the presence of high GADA titer was a significant predictor of insulin requirement (P<0.0001, OR=6.95).
CONCLUSIONS:
High GADA titer, BMI ??? 25, ZnT8 and IA-2IC positivity and sulfonylurea treatment, in the first year from diagnosis, significantly increase the progression toward insulin requirement in LADA patients
Data Study Group Final Report: STC
No full textData Study Groups are week-long events at The Alan Turing Institute bringing together some of the country’s top talent from data science, artificial intelligence, and wider fields, to analyse real-world data science challenges.
Bandwidth allocation and understanding user behaviour
The main challenge was to understand the user behaviour of the stc users, the majority of which use a fraction of their assigned bandwidth. Thus, there is a significant potential for cost savings both for stc and their users.
To solve this problem, we need to complete the following tasks:
Identify customers, who underutilise their connection and identify cell phone towers which have spare capacity to accommodate the additional traffic
Map customers to cells with sufficient capacit
Regional and temporal changes in AIDS in Europe before HAART
No full textIn a prospective observational study 4485 patients from 46 clinical centres in 17 European countries were followed between April 1994 and November 1996. Information on AIDS-defining events (ADEs) were collected together with basic demographic data, treatment history and laboratory results. The centres were divided into four geographical regions (north, central, south-west and south-east) so that it was possible to identify any existing regional differences in ADEs. The regional differences that we observed included a higher risk of all forms of Mycobacterium tuberculosis infections (Tb) and wasting disease in the south-west and an increased risk of infections with the Mycobacterium avium complex (MAC) in the north. In Cox multivariable analyses, where north was used as the reference group, we observed hazard ratios of 6.87, 7.77, 2.29 and 0.16 (P < 0.05 in all cases) for pulmonary Tb, extrapulmonary Tb, wasting disease and MAC respectively in the south-west. Pneumocystis carinii pneumonia (PCP) was less commonly diagnosed in the central region (RH = 0.51, 95% CI 0.32-0.79, P = 0.003) and most common in the south-east (RH = 1.04, 95% CI 0.71-1.51, P = 0.85). Comparisons with a similar 'AIDS in Europe' study that concentrated on the early phase of the epidemic reveal that most of the regional differences that were observed in the 1980s still persist in the mid-1990s
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