170,590 research outputs found
Late referral for dialysis: improving the management of chronic renal disease
No full textBackground: Timely nephrological referral of patients with chronic renal failure (CRF) is important, but referral at a late stage of disease is common. Aim: To investigate whether late referral of patients is avoidable, and where the missed opportunities lie. Design: Prospective ascertainment of new cases and comprehensive review of pre-end stage history. Methods: Patients admitted to Bristol and Portsmouth renal units for chronic RRT between June 1997 and May 1998 were identified from computer databases. Data were collected from case notes and hospital records, and a self-administered patient questionnaire. Late referral, defined as dialysis within 4 months of first referral to a dialysing nephrologist, was categorized by algorithm as unavoidable or avoidable. Results: Of 250 patients, 96 (38%) were referred late. Forty-three (45%) had definite avoidable reasons: 35 (37%) with raised serum creatinine for a median 3.7 years (IQR 1.5–8.2) before referral, and eight (8%) with risk factors for renal disease but scant assessment of renal function; 12/43 (31%) had a diagnosis of diabetic nephropathy. Late referred patients were less likely to receive standard renal therapies for chronic renal failure, were in a poorer clinical state at start of RRT, and more often required emergency dialysis, compared to patients referred early. Late referrals were as likely from a hospital as a primary care physician. Discussion: A significant proportion of patients are avoidably referred to a dialysing renal unit at a very late stage. Guidelines on referral should be developed by nephrologists, primary and secondary care physicians, and patient groups, and further research is needed into the cost-effectiveness of early referral strategies
"Practical Knowledge" and Perceptions of Antibiotics and Antibiotic Resistance Among Drugsellers in Tanzanian Private Drugstores.
No full textStudies indicate that antibiotics are sold against regulation and without prescription in private drugstores in rural Tanzania. The objective of the study was to explore and describe antibiotics sale and dispensing practices and link it to drugseller knowledge and perceptions of antibiotics and antibiotic resistance. Exit customers of private drugstores in eight districts were interviewed about the drugstore encounter and drugs bought. Drugsellers filled in a questionnaire with closed- and open-ended questions about antibiotics and resistance. Data were analyzed using mixed quantitative and qualitative methods. Of 350 interviewed exit customers, 24% had bought antibiotics. Thirty percent had seen a health worker before coming and almost all of these had a prescription. Antibiotics were dispensed mainly for cough, stomachache, genital complaints and diarrhea but not for malaria or headache. Dispensed drugs were assessed as relevant for the symptoms or disease presented in 83% of all cases and 51% for antibiotics specifically. Non-prescribed drugs were assessed as more relevant than the prescribed. The knowledge level of the drugseller was ranked as high or very high by 75% of the respondents. Seventy-five drugsellers from three districts participated. Seventy-nine percent stated that diseases caused by bacteria can be treated with antibiotics but 24% of these also said that antibiotics can be used for treating viral disease. Most (85%) said that STI can be treated with antibiotics while 1% said the same about headache, 4% general weakness and 3% 'all diseases'. Seventy-two percent had heard of antibiotic resistance. When describing what an antibiotic is, the respondents used six different kinds of keywords. Descriptions of what antibiotic resistance is and how it occurs were quite rational from a biomedical point of view with some exceptions. They gave rise to five categories and one theme: Perceiving antibiotic resistance based on practical experience. The drugsellers have considerable "practical knowledge" of antibiotics and a perception of antibiotic resistance based on practical experience. In the process of upgrading private drugstores and formalizing the sale of antibiotics from these outlets in resource-constrained settings, their "practical knowledge" as well as their perceptions must be taken into account in order to attain rational dispensing practices
Old versus new antiepileptic drugs: the SANAD study.
No full textComment on
The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial. [Lancet. 2007]The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial.
Marson AG, Al-Kharusi AM, Alwaidh M, Appleton R, Baker GA, Chadwick DW, Cramp C, Cockerell OC, Cooper PN, Doughty J, et al.
Lancet. 2007 Mar 24; 369(9566):1016-26. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial. [Lancet. 2007]The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial.
Marson AG, Al-Kharusi AM, Alwaidh M, Appleton R, Baker GA, Chadwick DW, Cramp C, Cockerell OC, Cooper PN, Doughty J, et al.
Lancet. 2007 Mar 24; 369(9566):1000-15
Increased risk of epilepsy in biopsy-verified celiac disease: a population-based cohort study.
No full textOBJECTIVES:
Celiac disease (CD) is associated with several neurologic disorders but it is unclear whether CD is associated with epilepsy. We therefore investigated whether biopsy-verified CD is associated with epilepsy.
METHODS:
Cohort study. Using biopsy report data from all Swedish pathology departments (n = 28), we identified individuals with CD who were diagnosed from 1969 to 2008 (Marsh 3: villous atrophy). Through Cox regression, we calculated hazard ratios (HRs) for epilepsy (defined as a diagnosis of epilepsy in the Swedish National Patient Register) in 28,885 individuals with CD and 143,166 controls matched for age, sex, calendar period, and county.
RESULTS:
Individuals with CD were at an increased risk of future epilepsy (HR = 1.42; 95% confidence interval [CI] = 1.24-1.62) (272 individuals with CD had a diagnosis of epilepsy vs an expected 192). The absolute risk of future epilepsy in patients with CD was 92/100,000 person-years (excess risk = 27/100,000 person-years). This risk increase was seen in all ages, including children with CD. The HR for having at least 2 interactions with health care due to epilepsy was 1.41 (95% CI = 1.19-1.66). When we restricted epilepsy to those with both a diagnosis of epilepsy and an independent record of antiepileptic drug prescriptions, CD was associated with a 1.43-fold increased risk of epilepsy (95% CI = 1.10-1.86).
CONCLUSION:
Individuals with CD seem to be at a moderately increased risk of epilepsy
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe 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
Mitomycin C in highly myopic eyes - Author reply
No full textOphthalmology. 2005 Feb;112(2):208-18; discussion 219.
Mitomycin C modulation of corneal wound healing after photorefractive keratectomy in highly myopic eyes.
Gambato C, Ghirlando A, Moretto E, Busato F, Midena E.
SourceRefractive Surgery Service and Antimetabolite Therapy Research Unit, Department of Ophthalmology, University of Padova, Padova, Italy.
Abstract
PURPOSE: To evaluate the role of topical mitomycin C in corneal wound healing (CWH) after photorefractive keratectomy (PRK) in highly myopic eyes.
DESIGN: Prospective, double-masked, randomized clinical trial.
PARTICIPANTS: Seventy-two eyes of 36 patients affected by high (>7 diopters) myopia.
METHODS: In each patient, one eye was randomly assigned to PRK with intraoperative topical 0.02% mitomycin C application, and the fellow eye was treated with a placebo. Postoperatively, mitomycin C-treated eyes received artificial tears (3 times daily, tapered in 3 months), whereas the fellow eye was treated with fluorometholone sodium 2% and artificial tears (3 times daily, tapered in 3 months).
MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), contrast sensitivity, manifest refraction, and biomicroscopy. Contrast sensitivity was determined using the Pelli-Robson chart. Corneal confocal microscopy documented CWH.
RESULTS: Mean follow-up was 18 months (range, 12-36). No side effects or toxic effects were documented. At 12-month follow-up examination, UCVAs (logarithm of the minimum angle of resolution) were 0.4+/-0.48 and 0.5+/-0.53 (P = .03) in mitomycin C-treated eyes and corticosteroid-treated eyes, respectively. At 1 year, corneal haze developed in 20% of corticosteroid-treated eyes, versus 0% of mitomycin C-treated eyes. At 12, 24, and 36 months, corneal confocal microscopy showed activated keratocytes and extracellular matrix significantly more evident in untreated eyes (Ps = 0.004, 0.024, and 0.046, respectively).
CONCLUSION: Topical intraoperative application of 0.02% mitomycin C can reduce haze formation in highly myopic eyes undergoing PRK.
Comment in
Ophthalmology. 2006 Feb;113(2):357; author reply 357-8
Dispelling the Myths Behind First-author Citation Counts
No full textWe 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
Telephone support for smoking cessation : the Swedish example
No full textBackground: Tobacco is a major public health problem that needs to be addressed. The Swedish quitline is a telephone-based free-of-charge tobacco cessation service.Objective: To study the effectiveness and the cost-effectiveness of the Swedish quitline. Methods : The study population comprised clients calling the quitline and returning a registration questionnaire mailed home to the caller directly after first call from April 1999 to November 2002. Each individual was followed up 12 months after first contact (follow-up questionnaire). All those returning the registration questionnaire were included in the study base. The questionnaires assessed point prevalence abstinence as well as several factors potentially related to abstinence. Study I comprised 496 and 629 smokers receiving a reactive and a proactive treatment respectively. Studies II, III and IV comprised all 1131 smokers who had signed up for smoking cessation treatment from February 2000 to November 2001. Of those, 741 individuals (66%) reporting to have been abstinent for at least 24 hours were examined in study II. In study III, a sample of 84 out of 475 non-responders were included in a drop-out analysis. Study IV, was based on 354 abstinent smokers. Outcome measures were cost per quitter and cost per life year saved ( LYS).Main findings: Factors significantly related to abstinence (I) included no nicotine use at baseline, the adjusted OR and 95% CI, being 6.4 (2.1-19.4), additional support from health care professionals 3.5 (1.0-12.3), additional social support 3.1 (1.6-6.1), absence of stress or depressive mood 2.7 (1.6-4.7), nicotine replacement therapy (NRT) for five weeks or more 2.1 (1.1-4.1), and no exposure to second-hand smoke 1.9 (1.1-3.3). High intensity of craving, irritability, apprehension/anxiety, difficulties concentrating, restlessness, depressed mood, and insomnia were related to unsuccessful quitting attempts (II). With the exception of insomnia all these symptoms comprised a factor labelled psychological which was related to unsuccessful quitting attempts. Using NRT for five weeks or longer was correlated with lower intensity of the psychological symptoms. Of the non-responders in study III, 39% claimed to have been smoke-free at the time they received the 12-month follow-up questionnaire compared with 31% of the responders in the original study population (III). The cost per quitter in the investigated cohort (IV) was 1062 USD and cost per life year saved was estimated to be 311 USD.Conclusions: The Swedish quitline proved to be a cost-effective intervention that significantly increased 12 month abstinence. Treatment efficacy may be further enhanced by focusing on factors identified in the different studies as being related to 12 month abstinence. Non-responders to the 12 month follow-up questionnaire were not more likely to be unsuccessful quitters.List of scientific papersI. Helgason AR, Tomson T, Lund KE, Galanti R, Ahnve S, Gilljam H (2004). Factors related to abstinence in a telephone helpline for smoking cessation. Eur J Public Health. 14(3): 306-10. https://pubmed.ncbi.nlm.nih.gov/15369039II. Tomson T, Toftgard M, Gilljam H, Helgason AR (2005). Symptoms in smokers trying to quit. [Submitted]III. Tomson T, Bjornstrom C, Gilljam H, Helgason A (2005). Are non-responders in a quitline evaluation more likely to be smokers? BMC Public Health. 5(1): 52. https://pubmed.ncbi.nlm.nih.gov/15910682IV. Tomson T, Helgason AR, Gilljam H (2004). Quitline in smoking cessation: a cost-effectiveness analysis. Int J Technol Assess Health Care. 20(4): 469-74. https://pubmed.ncbi.nlm.nih.gov/15609797</p
Towards case-mix-adjusted international renal registry comparisons: how can we improve data collection practice?
No full textLazarus Karamadoukis, David Ansell, Robert N. Foley, Stephen Peter McDonald, Charles R. V. Tomson, Lilyanna Trpeski and Fergus J. Caske
A Multi-Language Comparison of Influences on Author Verification using Character N-Grams
No full textWe create a new multi-language corpus for author verification based on Wikipedia talkpages, and evaluate the influence that differences in topic and time have on character n-gram author profiles. Topic alignment between two texts is found to increase author verification precision, and an authors writing style is found to change over time, but not more significantly after 3 years than after 1 year.Information ArchitectureWISElectrical Engineering, Mathematics and Computer Scienc
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