1,720,971 research outputs found
Oesophageal candidiasis: does taking a biopsy affect the outcome? A dgh experience
No full textIntroduction: Oesophageal Candidiasis (OC) is strongly associated with various immunocompromised states. We noted locally that some endoscopists feel confident in their ability to identify the condition visually at OGD, and therefore do not biopsy the oesophagus. The aim of this retrospective study was to analyse the outcomes for a cohort of patients diagnosed with OC at endoscopy to see whether oesophageal biopsy affected outcomes.Method: All OGDs performed at DCH over one year (21/03/13–21/03/14) were reviewed. Patients diagnosed with OC at endoscopy were followed up. Three groups were identified: Group 1, Histology proven OC; Group 2, oesophageal histology suggesting alternative diagnosis; and Group 3, patients not biopsied. Diagnoses and patient outcomes were assessed between 10 and 22 months following the initial OGD.Results: 3375 OGDs were performed. 103 patients (63 female, 40 male), mean age 72.9 years, (range 34–97 yrs) had endoscopic evidence of possible OC. 49 patients (47.5%) had an oesophageal biopsy. Only 61% of these biopsies confirmed OC (Group 1); of these patients one was subsequently diagnosed with HIV, seven took inhaled steroids, seven had cancer, one had intercurrent sepsis, one was reflux related, one had poor diabetic control, two took continuous antibiotics and ten were on a PPI. Mortality in Group 1 was 10% within one month following OGD (all were related to disseminated malignancy). 39% of biopsied patients had histology negative for candida (Group 2) with the following alternative diagnoses made histologically: 16 had reflux oesophagitis, one had HSV oesophagitis, one had eosinophilic oesophagitis and one had bisophosphonate-related oesophagitis. Mortality in Group 2 was 0%. 52.5% of patients with suspected OC did not receive a biopsy (Group 3). Four patients had contraindications to biopsy: two oesophageal varices, two were over anti-coagulated. 57% of these patients had strong risk factors for OC pre-endoscopy: 12 were on long term inhaled/oral steroid, 11 had cancer, three were acutely malnourished, two had decompensated liver disease, and two were on other immunosuppressant medication. Mortality in Group 3 was high: 42.6% in six months (Range: 0–17 months) with varied causes of death that included fungal pneumonia and colonic adenocarcinoma.Conclusion: We suggest all patients with endoscopically suspected OC should be biopsied unless there are compelling reasons not to, as up to 40% of patients will have an alternative diagnosis despite similar endoscopic appearances. Histologically proven OC is often associated with immunocompromise, it is therefore important for endoscopists to advise upon further investigation, particularly in the setting of GP open access endoscopy. Our data suggest a high mortality in this group although treatable diseases may be found.Disclosure of interest: None Declared
PTU-101 The Introduction of a pathway featuring the use of nasal bridles improves outcomes following percutaneous endoscopic gastrostomy insertion amongst an elderly cohort
No full textIntroduction: Percutaneous endoscopic gastrostomy (PEG) tubes are associated with complications and excess mortality if mistimed or inserted inappropriately. A 2008 anonymised NCEPOD review highlighted a very high mortality rate of 43% at one week post-insertion.1 The aim of this study was to see if the introduction of a new pathway, featuring the use of nasal bridles, could improve PEG related outcomes amongst inpatients at SRH - a hospital where >25% of inpatients are over 75.Methods: Nasal bridles for nasogastric (NG) tubes and a new multi-disciplinary pathway were introduced at SRH: May-Sept 2014. In Dec-2015 the notes for all inpatients receiving a PEG tube were reviewed. Group 1 – patients receiving PEG tube the year before the changes: [May 2013 – May 2014]. Group 2, the year after: [Sept 2014 – Sept 2015]. Prior modes of feeding and outcomes were analysed: 1 outcome: 30 day mortality. 2 outcomes: major complications; length of stay.Results: 58 inpatients received a PEG tube during the study period. Full records were unavailable for 2 from each group. Of the 54 remaining: 27 were male, 27 female; mean age: 76 (range: 34–95). Group 1: 29 patients (53.7%); None received a bridle or parenteral nutrition. 27.6% of patients multiply failed conventional NG progressing straight to PEG - mean age of subgroup: 85 (range: 76–93). 1 outcome:30 day mortality - 27.6%. 2 outcomes: two suffered a major complication (intra-abdominal sepsis); mean length of stay was 61 days. Group 2: 25 patients (46.3%); No patients received parenteral nutrition but 36% of patients received a nasal bridle prior to PEG - the mean age of this sub-group was 82 (range: 78–95). The mean delay from placement of bridle to PEG tube insertion was 26.5 days. 1 outcome outcomes: 30 day mortality - 12%. 2 outcomes: there were no major complications and the mean length of stay was 51 days.Conclusion: Decisions regarding the timing of PEG tube insertion are fraught with difficulty. The changes have greatly improved outcomes following PEG tube insertion locally. We, the authors, feel this is primarily because: 1) amongst a very elderly subgroup, nasal bridles helped to appropriately delay PEG tube insertion until nutrition was optimised; 2) the protocol served to improve communication between healthcare professionals preventing inappropriate PEG insertion. The changes were inexpensive but also contributed to saving the hospital up to 250 excess bed days, worth over £70,000
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe 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
DEVELOPMENT OF MACHINE LEARNING MODELS TO PREDICT RISK OF PATHOLOGY OR NEED FOR INTERVENTION AMONGST ADULT PATIENTS UNDERGOING COLONOSCOPY
No full text54REVIEW OF OUTCOMES OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT IN AN ELDERLY COHORT FOLLOWING THE INTRODUCTION OF A REFERRAL PATHWAY
No full textVariations on the Author
Get PDF“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
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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