592 research outputs found
Patterns and frequency of recurrences of squamous cell carcinoma of the vulva
Full text linkJorien M. Woolderink, Geertruida H. de Bock, Joanne A. de Hullu, Margaret J. Davy, Ate G.J. van der Zee, Marian J.E. Mourit
Additional file 3: of Digital breast tomosynthesis for breast cancer screening and diagnosis in women with dense breasts â a systematic review and meta-analysis
Full text linkSubgroup analysis - Recall rate of DBT and DM in screening studies using two study groups by outcome definition. (DOCX 30 kb
"Timed Up & Go": a screening tool for predicting 30-day morbidity in onco-geriatric surgical patients? A multicenter cohort study.
Full text linkTo determine the predictive value of the "Timed Up & Go" (TUG), a validated assessment tool, on a prospective cohort study and to compare these findings to the ASA classification, an instrument commonly used for quantifying patients' physical status and anesthetic risk.In the onco-geriatric surgical population it is important to identify patients at increased risk of adverse post-operative outcome to minimize the risk of over- and under-treatment and improve outcome in this population.280 patients ≥70 years undergoing elective surgery for solid tumors were prospectively recruited. Primary endpoint was 30-day morbidity. Pre-operatively TUG was administered and ASA-classification was registered. Data were analyzed using multivariable logistic regression analyses to estimate odds ratios (OR) and 95% confidence intervals (95%-CI). Absolute risks and area under the receiver operating characteristic curves (AUC's) were calculated.180 (64.3%) patients (median age: 76) underwent major surgery. 55 (20.1%) patients experienced major complications. 50.0% of patients with high TUG and 25.6% of patients with ASA≥3 experienced major complications (absolute risks). TUG and ASA were independent predictors of the occurrence of major complications (TUG:OR 3.43; 95%-CI = 1.14-10.35. ASA1 vs. 2:OR 5.91; 95%-CI = 0.93-37.77. ASA1 vs. 3&4:OR 12.77; 95%-CI = 1.84-88.74). AUCTUG was 0.64 (95%-CI = 0.55-0.73, p = 0.001) and AUCASA was 0.59 (95%-CI = 0.51-0.67, p = 0.04).Twice as many onco-geriatric patients at risk of post-operative complications, who might benefit from pre-operative interventions, are identified using TUG than when using ASA
Comparison of analysis methods and design choices for treatment-by-period interaction in unidirectional switch designs:a simulation study
Full text linkBackground: Due to identifiability problems, statistical inference about treatment-by-period interactions has not been discussed for stepped wedge designs in the literature thus far. Unidirectional switch designs (USDs) generalize the stepped wedge designs and allow for estimation and testing of treatment-by-period interaction in its many flexible design forms. Methods: Under different forms of the USDs, we simulated binary data at both aggregated and individual levels and studied the performances of the generalized linear mixed model (GLMM) and the marginal model with generalized estimation equations (GEE) for estimating and testing treatment-by-period interactions. Results: The parallel group design had the highest power for detecting the treatment-by-period interactions. While there was no substantial difference between aggregated-level and individual-level analysis, the GLMM had better point estimates than the marginal model with GEE. Furthermore, the optimal USD for estimating the average treatment effect was not efficient for treatment-by-period interaction and the marginal model with GEE required a substantial number of clusters to yield unbiased estimates of the interaction parameters when the correlation structure is autoregressive of order 1 (AR1). On the other hand, marginal model with GEE had better coverages than GLMM under the AR1 correlation structure. Conclusion: From the designs and methods evaluated, in general, parallel group design with a GLMM is, preferred for estimation and testing of treatment-by-period interaction in a clustered randomized controlled trial for a binary outcome.</p
Outstanding negative prediction performance of solid pulmonary nodule volume AI for ultra-LDCT baseline lung cancer screening risk stratification
Full text linkOBJECTIVE: To evaluate performance of AI as a standalone reader in ultra-low-dose CT lung cancer baseline screening, and compare it to that of experienced radiologists.METHODS: 283 participants who underwent a baseline ultra-LDCT scan in Moscow Lung Cancer Screening, between February 2017-2018, and had at least one solid lung nodule, were included. Volumetric nodule measurements were performed by five experienced blinded radiologists, and independently assessed using an AI lung cancer screening prototype (AVIEW LCS, v1.0.34, Coreline Soft, Co. ltd, Seoul, Korea) to automatically detect, measure, and classify solid nodules. Discrepancies were stratified into two groups: positive-misclassification (PM); nodule classified by the reader as a NELSON-plus /EUPS-indeterminate/positive nodule, which at the reference consensus read was < 100 mm3, and negative-misclassification (NM); nodule classified as a NELSON-plus /EUPS-negative nodule, which at consensus read was ≥ 100 mm3.RESULTS: 1149 nodules with a solid-component were detected, of which 878 were classified as solid nodules. For the largest solid nodule per participant (n = 283); 61 [21.6 %; 53 PM, 8 NM] discrepancies were reported for AI as a standalone reader, compared to 43 [15.1 %; 22 PM, 21 NM], 36 [12.7 %; 25 PM, 11 NM], 29 [10.2 %; 25 PM, 4 NM], 28 [9.9 %; 6 PM, 22 NM], and 50 [17.7 %; 15 PM, 35 NM] discrepancies for readers 1, 2, 3, 4, and 5 respectively.CONCLUSION: Our results suggest that through the use of AI as an impartial reader in baseline lung cancer screening, negative-misclassification results could exceed that of four out of five experienced radiologists, and radiologists' workload could be drastically diminished by up to 86.7%.</p
Optimal unidirectional switch designs
Full text linkStepped wedge designs and delayed start designs can all be considered as special cases of the so-called unidirectional switch design. This paper provides optimal proportions of clusters that are allocated to switch patterns in a unidirectional switch design to minimize the asymptotic variance of the treatment effect estimator. This unique optimal design applies to certain cross-sectional and longitudinal variance component models. When the intraclass correlation coefficient is zero, the optimal unidirectional switch design coincides with the classic (cluster) parallel group design. The optimal unidirectional switch design is more efficient than the optimal stepped wedge design and delayed start designs. Compared with the uniform unidirectional switch design, the efficiency gain of the optimal unidirectional switch design can be substantial, but it depends on the intraclass correlation and the cluster size. We also showed that augmenting the optimal stepped wedge design with pure control pattern is more efficient than the optimal stepped wedge design. In addition, robust minimax design for unidirectional switch design, delayed start design, and stepped wedge design are provided
Severity, not type, is the main predictor of decreased quality of life in elderly women with urinary incontinence: a population-based study as part of a randomized controlled trial in primary care
No full textSeverity, not type, is the main predictor of decreased quality of life in elderly women with urinary incontinence Barentsen, J.A.; Visser, Els; Hofstetter, H.; Maris, A.M.; Dekker, J.H.; de Bock, G.H. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract Background: Urinary incontinence negatively influences the lives of 25-50% of elderly women, mostly due to feelings of shame and being limited in activities and social interactions. This study explores whether differences exist between types of urinary incontinence (stress, urgency or mixed) and severity of the symptoms, with regard to their effects on generic and condition-specific quality of life. Methods: This is a cross-sectional study among participants of a randomized controlled trial in primary care. A total of 225 women (aged ≥ 55 years) completed a questionnaire (on physical/emotional impact and limitations) and were interviewed for demographic characteristics and co-morbidity. Least squares regression analyses were conducted to estimate differences between types and severity of urinary incontinence with regard to their effect on quality of life. Results: Most patients reported mixed urinary incontinence (50.7%) and a moderate severity of symptoms (48.9%). Stress urinary incontinence had a lower impact on the emotional domain of condition-specific quality of life compared with mixed urinary incontinence (r = −7.81). There were no significant associations between the types of urinary incontinence and generic quality of life. Severe symptoms affected both the generic (r = −0.10) and condition-specific (r = 17.17) quality of life. Conclusions: The effects on condition-specific quality of life domains differ slightly between the types of incontinence. The level of severity affects both generic and condition-specific quality of life, indicating that it is not the type but rather the severity of urinary incontinence that is the main predictor of decreased quality of life
Patients' beliefs about the aims of breast cancer follow-up: A qualitative study
No full textObjective: To explore patients' beliefs about the aims of breast cancer follow-up, and to compare these with the current literature on best practice for survivor care. Study design: We reviewed the literature on breast cancer and interviewed 61 women with a history of early-stage breast cancer. By means of descriptive content analysis with qualitative and quantitative elements, the patients' verbatim responses were thematically and independently analysed by two researchers. Results were compared with current literature and breast cancer guidelines. Results: When patients were asked to comment on what they thought the aims of breast cancer follow-up were, they most frequently mentioned 'detection of recurrence' and 'receiving reassurance', followed by 'receiving psychological support', and 'collecting data to evaluate care'. Some patients explicitly mentioned 'surveillance for metastatic disease' as an aim of follow-up. However, some patients believed that breast cancer could not recur after 2-5 years of follow-up, and that recurrences could not develop directly after or between follow-up appointments. In relation to follow-up appointments, some patients experienced anxiety, while others felt it made them confront their breast cancer history. Conclusions: Patients' beliefs are often not in line with guidelines. Educating patients about the aims of follow-up, and the evidence underlying it, might be important, in part to make patients' expectations more realistic. (C) 2016 Elsevier Ireland Ltd. All rights reserved
Human-recognizable CT image features of subsolid lung nodules associated with diagnosis and classification by convolutional neural networks
Full text linkObjectives The interpretability of convolutional neural networks (CNNs) for classifying subsolid nodules (SSNs) is insufficient for clinicians. Our purpose was to develop CNN models to classify SSNs on CT images and to investigate image features associated with the CNN classification. Methods CT images containing SSNs with a diameter of</p
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