99,201 research outputs found
Resource use by patients hospitalized with community-acquired pneumonia in Europe : analysis of the REACH study
No full textBackground: Management of community-acquired pneumonia (CAP) places a considerable burden on hospital resources. REACH was a retrospective, observational study (NCT01293435) involving adults ≥18 years old hospitalized with CAP and requiring in-hospital treatment with intravenous antibiotics conducted to collect data on current clinical management patterns and resource use for CAP in hospitals in ten European countries.Methods: Data were collected via electronic Case Report Forms detailing patient and disease characteristics, microbiological diagnosis, treatments before and during hospitalization, clinical outcomes and health resource consumption.Results: Patients with initial antibiotic treatment modification (n = 589; 28.9%) had a longer mean hospital stay than those without (16.1 [SD: 13.1; median 12.0] versus 11.1 [SD: 8.9; median: 9.0] days) and higher ICU admission rate (18.0% versus 11.9%). Septic shock (6.8% versus 3.0%), mechanical ventilation (22.2% versus 9.7%), blood pressure support (fluid resuscitation: 19.4% versus 11.4%), parenteral nutrition (6.5% versus 3.9%) and renal replacement therapy (4.2% versus 1.4%) were all more common in patients with treatment modification than in those without. Hospital stay was longer in patients with comorbidities than in those without (mean 13.3 [SD: 11.1; median: 10.0] versus 10.0 [SD: 7.5; median: 8.0] days).Conclusions: Initial antibiotic treatment modification in patients with CAP is common and is associated with considerable additional resource use. Reassessment of optimal management paradigms for patients hospitalized with CAP may be warranted
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
Assessment of the rate of non-responders to latanoprost therapy
No full textPurpose: To determine the rate of non-responders to latanoprost therapy in patients with POAG or OHT. Methods: Two hundred and eighty newly diagnosed untreated POAG-OHT consecutive patients or patients treated only with a beta-blocker were enrolled in the study after proper wash-out. Ten academic italian centres participated in this study. All patients were put on latanoprost therapy for one month. Patients were divided into 3 groups according to the level of IOP reduction after one month of latanoprost therapy: non-responders (IOP reduction 15% but 30%). Non-responders entered a randomized cross-over study in which the efficacy of timolol, brimonidine, and pilocarpine was tested. Each treatment period lasted 30 days. Iris colour, axial length, refraction, gonioscopy were the variables tested as predictors of treatment efficacy in lowering IOP. Results: Mean baseline IOP was 23.6 mmHg (sd 2.7) and, after 1 month of therapy with latanoprost, mean IOP was lowered to 16.8 mmHg (sd 2.6) with an average effect of 28.8%. Non-responders rate was 4.6%, while hyper-responders were 27% of the patients. Non-responders had a significant reduction of IOP after brimonidine (p < 0.05), while after timolol and pilocarpine the decrease in IOP did not reach statistical significance. Conclusions: A low rate of non-responders to latanoprost was found in this multicentric prospective study; in non-responders patients only brimonidine, as compared with timolol and pilocarpine, was able to effectively lower IOP
Sampling and Surveying Hard-to-Reach Populations for Demographic Research
No full textBecause household-based survey designs are notoriously ineffective in studying hard-to-reach groups such as irregular migrants, these groups, however numerically large they may be, are rarely represented in demographic analyses. In this paper, we report on the application of a workplace-based stratified probability sampling design, response rate, and item-specific refusals in a recent study of irregular female migrants from Tajikistan, Kyrgyzstan, and Uzbekistan working in bazaars, eateries, and small retail outlets in Moscow, Russia. We argue that workplace-based survey, while not flawless, provides a uniquely feasible and cost-effective tool for studying irregular migrants and other marginalized groups.Central Asia, migration, Russia, sampling, survey methodology
A Pilot Study Investigating the Feasibility, Reach-Out, Acceptability, Fidelity, and Efficacy of a Group Laughie Prescription on the Well-Being of Earthquake Survivors in Türkiye
No full textMental health and quality of life may be negatively impacted among earthquake survivors. This pilot study evaluates the use of and reports on the preliminary effects of participating in a 1-minute Laughie (Laugh Intentionally Everyday) Laughter Prescription on well-being in earthquake survivors in Türkiye. A Group Laughie intervention was delivered using a within-subject (n = 20; M age = 34.78 ± 6.65; 14 female) pretest-posttest design. Group Laughies were delivered once a day over 2 weeks with participants prescribed to further laugh with the Group Laughie recording twice a day, resulting in 3 minutes of intentional laughter daily. Data were collected using a range of questionnaires to track feasibility, reach-out, acceptability, fidelity, and efficacy, including Laughie Checklists, a Post-Intervention Perceived Impact Measure in the form of the Positive Psychology One-off Post-intervention measure, and the World Health Organization (WHO-5) well-being index. Results indicated high intervention fidelity using Laughie Checklists and positive post-intervention perceived impact using the 11-point Likert-scaled PPOP (x = 7.62 ± 1.44). After the intervention, a statistically significant difference (p < 0.001) was found between WHO-5 well-being index pretest scores (x = 2.16 ± 1.00) and post-test (x = 4.08 ± 0.24). This study demonstrated beneficial effects of the Laughie prescription on earthquake survivors. This is the first intervention to explore an online Group Laughie intervention. Health professionals and especially nurses can use the 1-minute Laughie prescription in the form of a Group Laughie intervention to increase the well-being of individuals and improve perceived mental health
06-06 “European Chemical Policy and the United States: The Impacts of REACH”
No full textThe European Union is moving toward adoption of its new Registration, Evaluation and Authorization of Chemicals (REACH) policy, an innovative system of chemicals regulation that will provide crucial information on the safety profile of chemicals used in industry. Chemicals produced elsewhere, such as in the United States, and exported to Europe will have to meet the same standards as chemicals produced within the European Union. What is at stake for the U.S. is substantial: we estimate that chemical exports to Europe that are subject to REACH amount to about 14 million per year. Even if, as the U.S. chemicals industry has argued, REACH is a needless mistake, it will be far more profitable to pay the modest compliance costs than to lose access to the enormous European market.
All repair and reconstruction. Techniques from the SANTI study group
No full textBackground: Combining an anterior cruciate ligament (ACL) reconstruction with an anterolateral ligament (ALL) reconstruction results in significant advantages including reduced graft rupture rates, a lower risk of reoperation for secondary meniscectomy, improved knee stability, and higher rates of return to preinjury levels of sport. Indications: The previously reported indications for combined ACL and ALL reconstruction are as follows: ACL reconstruction revision; high-grade pivot shift test; long-term ACL rupture; young patients; pivoting activities; concomitant medial meniscus repair, and, specifically, regarding the ALL repair, it must be an acute surgery (within 15 days from injury). Technique Description: Several modern techniques have been described to repair and reconstruct the ALL. This technical note details a number of these techniques performed by the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group. Results: First, we describe a combined ACL reconstruction and double-bundle ALL reconstruction using hamstring autograft. Secondly, we describe a single-bundle ALL reconstruction using gracilis autograft. Thirdly, we describe an ALL reconstruction technique using a knotless soft anchor, which provides shallow fixation and prevents tunnel convergence. Finally, we describe a technique for ALL repair. Conclusion: Several techniques have been described to repair and reconstruct the ALL, all offering significant advantages over an isolated ACL reconstruction. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication
Robust automated detection of microstructural white matter degeneration in Alzheimer’s disease using machine learning classification of multicenter DTI data
No full textDiffusion tensor imaging (DTI) based assessment of white matter fiber tract integrity can support the diagnosis of Alzheimer’s disease (AD). The use of DTI as a biomarker, however, depends on its applicability in a multicenter setting accounting for effects of different MRI scanners. We applied multivariate machine learning (ML) to a large multicenter sample from the recently created framework of the European DTI study on Dementia (EDSD). We hypothesized that ML approaches may amend effects of multicenter acquisition. We included a sample of 137 patients with clinically probable AD (MMSE 20.6±5.3) and 143 healthy elderly controls, scanned in nine different scanners. For diagnostic classification we used the DTI indices fractional anisotropy (FA) and mean diffusivity (MD) and, for comparison, gray matter and white matter density maps from anatomical MRI. Data were classified using a Support Vector Machine (SVM) and a Naïve Bayes (NB) classifier. We used two cross-validation approaches, (i) test and training samples randomly drawn from the entire data set (pooled cross-validation) and (ii) data from each scanner as test set, and the data from the remaining scanners as training set (scanner-specific cross-validation). In the pooled cross-validation, SVM achieved an accuracy of 80% for FA and 83% for MD. Accuracies for NB were significantly lower, ranging between 68% and 75%. Removing variance components arising from scanners using principal component analysis did not significantly change the classification results for both classifiers. For the scanner-specific cross-validation, the classification accuracy was reduced for both SVM and NB. After mean correction, classification accuracy reached a level comparable to the results obtained from the pooled cross-validation. Our findings support the notion that machine learning classification allows robust classification of DTI data sets arising from multiple scanners, even if a new data set comes from a scanner that was not part of the training sample
Effectiveness of brief schema group therapy for borderline personality disorder symptoms : a randomized pilot study
No full textBackground and objectives Schema group therapy is a potentially cost-effective treatment for borderline personality disorder (BPD). We piloted the feasibility and effectiveness of a 20-session schema group therapy without individual therapy among psychiatric BPD outpatients in a randomized pilot study registered as a clinical trial (ISRCTN76381242). Methods Altogether 42 psychiatric outpatients diagnosed with BPD were randomized 2:1 to a 20-session weekly schema group therapy plus treatment as usual (TAU) (n = 28) vs. a control group with TAU alone (n = 14). The primary outcome was decline of BPD symptoms in the short Borderline Symptom List (BSL-23) score. Secondary outcomes were decline in symptoms of anxiety, depression, alcohol use, and improvement in functioning and schema modes. Two external experts evaluated validity of the intervention based on videotaped sessions. Results Overall, 23 schema group therapy patients (82%) and 12 controls (86%) completed their treatment. Treatment validity good or very good. However, no significant differences emerged in the primary outcome mean BSL-23 decline (6.95 [SE 5.91] in group schema therapy vs. 12.55 [4.85] in TAU) or in any of the secondary outcome measures. Limitations Despite randomization, the TAU subgroup had non-significantly higher baseline scores in most measures. Small sample size predisposing to type II errors; reliance on self-reported outcomes. Conclusions Schema group therapy was feasible for psychiatric outpatients with BPD. However, in this small pilot study we did not find it more effective than TAU. Effectiveness of this short intervention remains open.Peer reviewe
Multiple parietal reach regions in humans: cortical representations for visual and proprioceptive feedback during on-line reaching
No full textReaching toward a visual target involves at least two sources of information. One is the visual feedback from the hand as it approaches the target. Another is proprioception from the moving limb, which informs the brain of the location of the hand relative to the target even when the hand is not visible. Where these two sources of information are represented in the human brain is unknown. In the present study, we investigated the cortical representations for reaching with or without visual feedback from the moving hand, using functional magnetic resonance imaging. To identify reach-dominant areas, we compared reaching with saccades. Our results show that a reach-dominant region in the anterior precuneus (aPCu), extending into medial intraparietal sulcus, is equally active in visual and nonvisual reaching. A second region, at the superior end of the parieto-occipital sulcus (sPOS), is more active for visual than for nonvisual reaching. These results suggest that aPCu is a sensorimotor area whose sensory input is primarily proprioceptive, while sPOS is a visuomotor area that receives visual feedback during reaching. In addition to the precuneus, medial, anterior intraparietal, and superior parietal cortex were also activated during both visual and nonvisual reaching, with more anterior areas responding to hand movements only and more posterior areas responding to both hand and eye movements. Our results suggest that cortical networks for reaching are differentially activated depending on the sensory conditions during reaching. This indicates the involvement of multiple parietal reach regions in humans, rather than a single homogenous parietal reach region
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