1,720,968 research outputs found
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
INTERNATIONAL VARIATION IN USE OF IMAGING FOR PATIENTS PRESENTING WITH RIGHT ILIAC FOSSA PAIN
No full textAim: To investigate variation in utilisation of diagnostic imaging for patients
presenting with right iliac fossa (RIF) pain across five countries.
Method: Prospective observational cohort study of adult (16 years and
above) patients presenting with RIF pain. The primary endpoint was the
overall imaging rate, including computed tomography (CT), magnetic
resonance (MRI), and ultrasound imaging. The secondary endpoint was the
negative appendicectomy rate (NAR; removal of a histologically normal
appendix).
Results: Data were collected in Ireland/UK (n1⁄47665; 169 centres), Italy
(n1⁄4782; 50 centres), and Spain/Portugal (n1⁄41046; 55 centres). Imaging
rates were lower in Ireland/UK (women: 74%, men: 41%) than in Italy
(women: 87%, men: 84%) and Spain/Portugal (89% for both women and
men). Overall CT and MRI scans rates were similar across all countries, but
ultrasound was more commonly used in Italy (77%) and Spain/Portugal
(81%) than Ireland/UK (46%). The overall NAR was higher in Ireland/UK
(16%) than in Italy (3%) and Spain/Portugal (6%).
Conclusions: Whilst rates of CT and MRI imaging were similar across the
five countries, the NAR was lowest in Italy and Spain/Portugal. It may be
possible to decrease the NAR in Ireland/UK without increasing the rate of
CT scanning
IDENTIFYING PATIENTS WITH RIGHT ILIAC FOSSA PAIN AT VERY LOW RISK OF APPENDICITIS: PROSPECTIVE, MULTICENTRE VALIDATION AND CALIBRATION OF RISK SCORES
No full text
Right Iliac Fossa Pain Treatment (RIFT) Study: protocol for an international, multicentre, prospective observational study
No full textEvaluation of appendicitis risk prediction models in adults with suspected appendicitis
Full text linkBackground: Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis.Methods: A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16-45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis).Results: Some 5345 patients across 154 UK hospitals were identified, of which two-thirds (3613 of 5345, 67.6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28.2 per cent) than men (120 of 993, 12.1 per cent) (relative risk 2.33, 95 per cent c.i. 1.92 to 2.84; P <0.001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut-off score 8 or less, specificity 63.1 per cent, failure rate 3.7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut-off score 2 or less, specificity 24.7 per cent, failure rate 2.4 per cent).Conclusion: Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision-making by identifying adults in the UK at low risk of appendicitis were identified
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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