102,498 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
Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection
No full textPresentes no The INSIGHT START Study Group: Beatriz Grinsztejn; Valdiléa Veloso; Sandra Wagner Cardoso (Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil)Data from randomized trials are lacking on the benefits and risks of initiating antiretroviral therapy in patients with asymptomatic human immunodeficiency virus (HIV) infection who have a CD4+ count of more than 350 cells per cubic millimeter
Surveillance of illness associated with pandemic (H1N1) 2009 virus infection among adults using a global clinical site network approach : the INSIGHT FLU 002 and FLU 003 studies
No full textAbstract: The novel pandemic influenza A (H1H1) 2009 virus spread rapidly around the world in 2009. The paucity of prospective international epidemiologic data on predictors of clinical outcomes with pandemic (H1N1) 2009 virus infection stimulated the INSIGHT network, an international network of community and hospital-based investigators, to commence two worldwide clinical observational studies to describe pandemic (H1N1) 2009 virus activity. The purpose of these two studies was to estimate the percent of adult patients with illness due to laboratory-confirmed pandemic (H1N1) 2009 virus infection that experience clinically significant outcomes and to study factors related to these outcomes. Enrollment commenced in October 2009 and will continue until August 2011: as of the end of 2010, 62 sites in 14 countries in Australasia (12 sites), Europe (37) and North America (13) have enrolled 1365 adult patients, with 1049 enrollments into the FLU 002 outpatient study and 316 into the FLU 003 hospitalization study. These in progress INSIGHT influenza observational studies may act as a model for obtaining epidemiological, clinical and laboratory information in future international disease outbreaks
Research, Analysis and Insight into National Standards (RAINS) Project Final Report: National Standards and the Damage Done
No full textThis is the final report of the Research Analysis and Insight into National Standards (RAINS) project, a three-year study of the enactment of the National Standards policy in six diverse primary and intermediate schools. This report provides an overview discussion of the pros and cons of the National Standards policy as experienced by staff, children and parents in the RAINS schools. It summarises the policy and methodological background to the research and the findings of the two previous RAINS reports. The report is also being accompanied by online case studies and other data files
Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study
No full textChronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice
Modelling solutions to the impact of COVID-19 on cardiovascular waiting Lists
No full textThis three-day virtual study group explored the challenges related to the delays in seeking and gaining access to cardiovascular treatments caused by the COVID-19 pandemic and the impact this will have upon waiting lists.Background: cardiovascular disease is the leading cause of death for men in the UK and second-most for women. During the first lockdown from March 2020, elective cardiac procedures and many outpatient consultations were postponed and a substantial number of appointments have not yet been rescheduled. In addition, those who were suffering from heart conditions did not present to their GP or hospital – either because they did not want to impact further on NHS resources, or through concern of being exposed to the virus. Clinicians have been able to report what has been happening with respect to the reduction in emergency cardiac admissions and procedures, as well as quantify the excess deaths from emergency cardiac conditions. They have not quantified the impact on outpatient consultations.It would be helpful to form a predictive model of the outcome of different strategies for recovery of the backlog in cardiac procedures and outpatient consultations, noting that a number of competing elements are at play including incident cases, prevalent cases, delayed cases, abandonment from changes in disease and deaths, as well as the capacity and capability of NHS services to respond. For example, given different strategies for recovery from this major perturbation to treatment, what would be the implications for treatment demand over timescales from say 6 months to several years? How should treatment be optimised given resource constraints? What would be the impact of additional waves of COVID-19 cases?Aims and objectives: this study group brought together researchers and clinicians to provide further insight into these complex challenges through a variety of mathematical approaches.Proposed issues explored related to:1. The overarching state of the delivery of elective cardiovascular procedures and outpatient consultations at the national level, as a result of the pandemic and how this plays out at regional or local (single NHS trust) levels.2. An exemplar procedure - Aortic Stenosis – for which there is a particularly well-defined data set and for which missed early intervention can lead to particularly adverse outcomes over the course of one or two years.3. An exemplar condition – chronic heart failure - treatment regimens for which are less well-defined, yet the missed appointments during the pandemic represent a major perturbation to care that may impact on the optimal management of resources within cardiology departments.These were discussed in light of the following concerns:Where people are not presenting to clinics now, what will the impact of this be further down the line, as their health issue has not gone away? If people don’t present for treatment but don’t die, what impact does that have on resources?What could the knock-on effect of additional lockdowns be?If and when hospitals return to normal, what would be the optimal way to recover from the backlog and avoid a situation where more urgent cases in poorer condition are prioritised over routine earlier interventions, leading to perpetual worse outcomes for everyone.How can we configure a decision support system that could enable day-to-day answers to these questions on the ground?Previous work through V-KEMS discussed general mathematical principles which was considered and a number of different scenarios were modelled.Following the event, Plus Magazine interviewed Dr Jess Enright (University of Glasgow) and Dr Ramesh Nadarajah (University of Leeds). Ramesh presented the challenges at the event and Jess was one of the modelers who helped to develop the event. The inspiring podcast can be heard here. A working paper is published below, which highlights the discussions that took place at the Study Group and the initial findings.<br/
Why START? Reflections that led to the conduct of this large long-term strategic HIV trial
No full textPresentes no INSIGHT Strategic Timing of AntiRetroviral Treatment Study Group: Beatriz Grinsztejn; Sandra Wagner Cardoso (Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil)
Severity of cardiovascular disease outcomes among patients with hiv is related to markers of inflammation and coagulation
No full textBackground: In the general population, raised levels of inflammatory markers are stronger predictors of fatal than nonfatal cardiovascular disease (CVD) events. People with HIV have elevated levels of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and D-dimer; HIV-induced activation of inflammatory and coagulation pathways may be responsible for their greater risk of CVD. Whether the enhanced inflammation and coagulation associated with HIV is associated with more fatal CVD events has not been investigated. Methods and Results: Biomarkers were measured at baseline for 9764 patients with HIV and no history of CVD. Of these patients, we focus on the 288 that experienced either a fatal (n=74) or nonfatal (n=214) CVD event over a median of 5 years. Odds ratios (ORs) (fatal versus nonfatal CVD) (95% confidence intervals [CIs]) associated with a doubling of IL-6, D-dimer, hsCRP, and a 1-unit increase in an IL-6 and D-dimer score, measured a median of 2.6 years before the event, were 1.39 (1.07 to 1.79), 1.40 (1.10 to 1.78), 1.09 (0.93 to 1.28), and 1.51 (1.15 to 1.97), respectively. Of the 214 patients with nonfatal CVD, 23 died during follow-up. Hazard ratios (95% CI) for all-cause mortality were 1.72 (1.28 to 2.31), 1.73 (1.27 to 2.36), 1.44 (1.15 to 1.80), and 1.88 (1.39 to 2.55), respectively, for IL-6, D-dimer, hsCRP, and the IL-6 and D-dimer score. Conclusions: Higher IL-6 and D-dimer levels reflecting enhanced inflammation and coagulation associated with HIV are associated with a greater risk of fatal CVD and a greater risk of death after a nonfatal CVD event. Clinical Trial Registration: URL: http://www.clinicaltrial.gov Unique identifier: SMART: NCT00027352, ESPRIT: NCT00004978, SILCAAT: NCT00013611
Research, Analysis and Insight into National Standards (RAINS) Project. First Report: Researching Schools’ Enactments of New Zealand’s National Standards Policy
No full textThis is the first report of the Research, Analysis and Insight into National Standards (RAINS) project, one year into a three-year study of the introduction of National Standards into New Zealand primary and intermediate schools
Research, Analysis and Insight into National Standards (RAINS) Project. Second Report: Understanding New Zealand’s Very Local National Standards
No full textThis is the second report of the Research, Analysis and Insight into National Standards (RAINS) project, a three-year study of the introduction of National Standards into New Zealand primary and intermediate schools
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