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1.
T. Thomas D. Gilbert P. V. Kaye I. Penman G. P. Aithal Krish Ragunath 《Surgical endoscopy》2010,24(5):1110-1116
Background
Endoscopic ultrasound (EUS) is useful for detecting depth of invasion and nodal involvement in patients with early Barrett’s neoplasia (EBN), precluding endoscopic management. This study aimed to determine whether the lesion morphology of the EBN shown on high-resolution endoscopy predicts EUS and histologic tumor stage. 相似文献2.
Darshini Govindasamy Jamilah Meghij Eyerusalem Kebede Negussi Rachel Clare Baggaley Nathan Ford Katharina Kranzer 《Journal of the International AIDS Society》2014,17(1)
Introduction
Several approaches have been taken to reduce pre-antiretroviral therapy (ART) losses between HIV testing and ART initiation in low- and middle-income countries, but a systematic assessment of the evidence has not yet been undertaken. The aim of this systematic review is to assess the potential for interventions to improve or facilitate linkage to or retention in pre-ART care and initiation of ART in low- and middle-income settings.Methods
An electronic search was conducted on Medline, Embase, Global Health, Web of Science and conference databases to identify studies describing interventions aimed at improving linkage to or retention in pre-ART care or initiation of ART. Additional searches were conducted to identify on-going trials on this topic, and experts in the field were contacted. An assessment of the risk of bias was conducted. Interventions were categorized according to key domains in the existing literature.Results
A total of 11,129 potentially relevant citations were identified, of which 24 were eligible for inclusion, with the majority (n=21) from sub-Saharan Africa. In addition, 15 on-going trials were identified. The most common interventions described under key domains included: health system interventions (i.e. integration in the setting of antenatal care); patient convenience and accessibility (i.e. point-of-care CD4 count (POC) testing with immediate results, home-based ART initiation); behaviour interventions and peer support (i.e. improved communication, patient referral and education) and incentives (i.e. food support). Several interventions showed favourable outcomes: integration of care and peer supporters increased enrolment into HIV care, medical incentives increased pre-ART retention, POC CD4 testing and food incentives increased completion of ART eligibility screening and ART initiation. Most studies focused on the general adult patient population or pregnant women. The majority of published studies were observational cohort studies, subject to an unclear risk of bias.Conclusions
Findings suggest that streamlining services to minimize patient visits, providing adequate medical and peer support, and providing incentives may decrease attrition, but the quality of the current evidence base is low. Few studies have investigated combined interventions, or assessed the impact of interventions across the HIV cascade. Results from on-going trials investigating POC CD4 count testing, patient navigation, rapid ART initiation and mobile phone technology may fill the quality of evidence gap. Further high-quality studies on key population groups are required, with interventions informed by previously reported barriers to care. 相似文献3.
Adrian Harnett 《Breast (Edinburgh, Scotland)》2010,19(3):159-162
Fractionation regimes for individual tumour sites have varied greatly across the UK for many years. This has been particularly true for breast cancer which accounts for up to 40% of a radiotherapy department’s work load. Over the last 30 years or so many UK oncology centres have coped with this large case load and a lack of megavoltage machines by reducing fractionation and routinely using internationally non standard regimes so that these regimes have themselves become one of the options for standard treatment. Nowadays, medicine is largely evidence based rather than historically relying more on clinical experience or intuition. Large studies particularly in the UK and Canada set out to address this question and have shown that fewer fractions are equivalent in terms of local recurrence, late tissue effects and cosmesis. Current studies are focusing on further hypofractionation and partial breast radiotherapy (see papers Yarnold (2010) Is it safe to push “hypofractionation” further?. The Breast (this issue). Lehman (2010) The less than whole breast radiotherapy approach. The Breast (this issue)). 相似文献
4.
Background
Endoscopic therapy has emerged as an alternative to surgical esophagectomy for the management of Barrett’s esophagus (BE)-associated neoplasia. Accurate pretreatment staging is essential to ensure an appropriate choice of therapy and optimal long-term outcomes. This study aimed to assess the frequency with which expert histopathologic review of biopsies combined with endoscopic mucosal resection (EMR) would alter the pretreatment diagnosis of BE-associated neoplasia.Methods
Patients referred to the Vanderbilt Barrett’s Esophagus Endoscopic Treatment Program (V-BEET) were retrospectively identified. Demographic, histopathologic, and endoscopic data were extracted from the medical record.Results
For this study, 29 subjects referred for endoscopic staging of BE fulfilled the entry criteria. The referral diagnosis was low-grade dysplasia (LGD) in 3 % (1/29), high-grade dysplasia (HGD) in 62 % (18/29), intramucosal adenocarcinoma (T1a) adenocarcinoma in 17 % (5/29), and invasive adenocarcinoma in 17 % (5/29) of the subjects. Expert histopathologic review of available referral biopsy specimens altered the diagnosis in 33 % (5/15) of the cases. Further diagnostic staging with EMR showed BE without dysplasia in 10 % (3/29), LGD in 14 % (4/29), HGD in 34 % (10/29), T1a adenocarcinoma in 28 % (8/29), and invasive adenocarcinoma in 14 % (4/29) of the patients. The combination of expert histopathologic review and EMR altered the initial diagnosis for 55 % (16/29) of the subjects, with 56 % (9/16) upstaged to more advanced disease and 44 % (7/16) downstaged to less advanced disease.Conclusions
The practice of combined expert histopathologic review and EMR alters the pretreatment diagnosis for the majority of patients with BE-associated neoplasia. Caution is advised for those embarking on endoscopic or surgical treatment for BE-associated neoplasia in the absence of these staging methods. 相似文献5.
《European Urology Supplements》2002,1(6):3-7
Objectives: Prostatic biopsy is a minor diagnostic procedure; despite the simplicity of execution this procedure can determine a high patients’ discomfort.Methods: We analyzed the experience reported in the literature concerning the pain and the anxiety, the role of local or intrarectal anesthesia and the complications related to prostatic biopsy. Key words used for the Medline search included: prostate cancer, biopsy, transrectal ultrasound anesthesia, complications.Results: The reduction of patients’ pre biopsy anxiety may help the physician to perform a better prostate biopsy. While the use of pre biopsy enemas seems questionable, the use of antibiotic prophylaxis is mandatory when the biopsy is transrectal and could be useful if the approach is transperineal. The use of anaesthesia (periprostatic local injection of lidocaine or intrarectal administration of lidocaine gel) seems to reduce patients’ discomfort. The higher is the number of biopsy cores, the greater is the need for anaesthesia.Conclusions: Trans-rectal ultrasound (TRUS) prostatic biopsy with a correct patient’s preparation has a limited impact on patient’s well-being. 相似文献
6.
AS Lau NS Upile MD Wilkie SC Leong AC Swift 《Annals of the Royal College of Surgeons of England》2014,96(4):307-310
Introduction
Sore throats and tonsillitis represent a considerable health burden as well as a significant source of expenditure for the National Health Service (NHS). As part of the recent NHS savings drive, the introduction of ‘procedures of low clinical effectiveness’ (PoLCE) lists has reinforced a large reduction in the number of tonsillectomies performed. We carried out a cross-sectional study of trends in emergency sore throat admissions in the context of the number of tonsillectomies performed.Methods
Hospital Episode Statistics (HES) data were extracted. Office for National Statistics data were also used.Results
Between 1991 and 2011, the overall tonsillectomy rate fell by 44%. In the same time, the admission rate for tonsillitis rose by 310% (Pearson’s r=–0.67, p=0.01). The peritonsillar abscess admission rate rose by 31% (r=–0.79, p<0.01). Between 1996 and 2011, the overall tonsillectomy rate fell by 41% and the retro and parapharyngeal abscess admission rate rose by 39% (r=–0.55, p=0.026). There was a 14% overall increase in tonsillectomy and sore throat associated bed days. This was despite the large fall in tonsillectomy numbers and the reduction in length of hospital stay.Conclusions
Efforts to reduce the tonsillectomy rate are correlated with a significant rise in emergency admissions. The rise in the retro and parapharyngeal abscess rate is perhaps most alarming given the very high mortality of these conditions. Bed day data suggest that no net saving has been made despite the new measures. 相似文献7.
Avramidis A Polyzos SA Moralidis E Arsos G Efstathiadou Z Karakatsanis K Grollios G Kita M 《Journal of bone and mineral metabolism》2008,26(6):635-641
Bisphosphonates have long been used with success in the treatment of Paget’s disease of bone (PDB). The aim of this study
was to evaluate the early (up to 3 months) and late (at 12 months) scintigraphic, biochemical, and clinical response to a
single intravenous infusion of zoledronic acid (ZOL) in patients with PDB serially assessed for 1 year. Nine patients with
30 bone lesions caused by PDB were prospectively evaluated. Total serum alkaline phosphatase (SAP) was serially measured.
Scintigraphy was performed before and at 3 and 12 months after ZOL administration, and bone lesions were assessed quantitatively.
After treatment, pain was alleviated in five of six patients starting from the first month. At 3 months, a significant decrease
of SAP levels compared to baseline values was found (322 ± 211 IU/l before vs. 101 ± 36 IU/l 3 months after; P < 0.05), with normal values attained in all except one patient. The scintigraphic index of involvement (SII), a marker for
the perpatient activity of the disease, was reduced from 14.4 ± 7.6 to 7.2 ± 1.8 (P = 0.01). The scintigraphic ratio (SR), a marker for the per-lesion activity of the disease, was reduced from 12.8 ± 7.7 to
7.0 ± 2.9 (P < 0.001). The values of markers of disease activity remained unchanged up to 12 months. A single intravenous administration
of ZOL leads to a favorable clinical, biochemical, and scintigraphic response in patients with PDB starting as early as 3
months after treatment and lasting no less than 12 months (i.e., considerably longer than the other existing therapies). 相似文献
8.
Tsuyoshi Tajika Tsutomu Kobayashi Tetsuya Kaneko Daisuke Tsunoda Kazuhiko Tsunoda Takahito Sutou Atsushi Yamamoto Kenji Takagishi 《Journal of orthopaedic science》2014,19(1):64-70
Background
This study investigated the etiology, personal risk factors, and quality of life related to Dupuytren’s disease among residents of a mountain village in Japan.Methods
Medical examinations were conducted of 401 adult residents (163 men, 238 women; average age of 66.7 years, range 40–92) of a mountain village in Japan. All had completed a self-administered questionnaire including items for gender, weight, height, dominant hand, occupation, history of diabetes mellitus, and frequency of smoking tobacco and drinking alcohol, in addition to EuroQol-5-Dimensions-3-level Japanese version. Blood samples were collected and assessed for biochemical markers related to Dupuytren’s disease. The Dupuytren’s disease diagnosis was based on clinical signs. Meyerding’s classification was used to ascertain the disease severity. After examining background data and physical examination data related to Dupuytren’s disease, we evaluated the association of Dupuytren’s disease with those factors using univariate and logistic regression analysis.Results
Dupuytren’s disease was diagnosed in 28 subjects (7.0 %). Univariate analysis revealed associations of age, male gender, occupation, history of diabetes mellitus, and alcohol intake with Dupuytren’s disease. Logistic regression analysis after adjustment for age revealed a significant association between Dupuytren’s disease and male gender, occupation, and history of alcohol intake. No significant difference was found between Dupuytren’s disease patients and participants without this disease in the scoring and visual analog scale of EuroQol. No relation was found in scoring, the visual analog scale of EuroQol, or grading of Meyerding’s classification in participants with Dupuytren’s disease.Conclusion
This cross-sectional study revealed Dupuytren’s disease in 7.0 % of 401 subjects among the general population of a mountain village in Japan. The prevalence is higher with age and is apparently associated with male gender, occupation and alcohol intake. Risk factors associated with Dupuytren’s disease were identified as age, male gender, occupation, and alcohol consumption habits. 相似文献9.
Selvi Ismail Aykac Aykut Baran Ozer Burlukkara Salih Ozok Ugur Sunay Mehmet Melih 《International urology and nephrology》2019,51(8):1303-1311
International Urology and Nephrology - To identify the prognostic factors that might predict morbidity related to Fournier’s gangrene (FG) and particularly requirement of skin grafting and... 相似文献
10.
Nuala McGrath Linda Richter Marie-Louise Newell 《Journal of the International AIDS Society》2013,16(1)
Introduction
Little is known about people diagnosed as HIV-positive who access HIV care early in their disease. In pre-ART studies published to date, only a minority of the participants have CD4>500 cells/µl.Methods
This cross-sectional study compared individuals presenting for HIV care with CD4>500 cells/µl, “pre-ART” (N=247), with individuals who had CD4<200 cells/µl or WHO Stage IV, “ART-eligible” (N=385). Baseline characteristics were contrasted between the two groups and logistic regression models used to explore group differences in: (a) being sexually active in the last month; (b) disclosure of HIV status to current partner; (c) knowing the HIV status of one''s current partner; and (d) condom use at last sex.Results
Pre-ART and ART-eligible individuals were similar in terms of a wide range of socio-demographic characteristics. Controlling for gender, only current sexual behaviour and HIV-testing history were significantly different between ART groups. In multivariable models, participants in the pre-ART group were twice as likely to be sexually active in the last month, OR 2.06 95% CI (1.32, 3.21), and to know their partner''s status, OR 1.95 (1.18, 3.22) compared to those in the ART-eligible group. Self-reported disclosure of HIV status to current sexual partner (71%), condom use at last sex (61%) and HIV concordancy within relationships were not significantly different between the two ART groups. Overall, 39% of the study participants reported knowing that they were in concordant HIV-positive relationships. Fifty-five percent of all participants reported not knowing their partner''s HIV status, only half of whom reported using a condom at last sex. Pre-ART individuals were significantly less likely to have tested HIV-positive for the first time in the last year and to have tested for sickness-related reasons than the ART-eligible group.Conclusions
Reported sexual risk behaviours by pre-ART individuals with CD4>500 cells/µl suggest a continued risk of onward HIV transmission. There is a need for positive prevention efforts to target this group given that current treatment guidelines do not provide them with ART. Strengthening support regarding disclosure, partner HIV testing and consistent condom use, and further promotion of HIV testing in the community to assist earlier diagnosis are urgently required. 相似文献11.
Margrethe Foss Hansen Gunnar Lose Ulrik Schiøler Kesmodel Kim Oren Gradel 《International urogynecology journal》2017,28(9):1309-1317
Introduction and hypothesis
Urethral injection therapy (UIT) has been performed since the early 20th century and a variety of agents have been launched. In 2006, polyacrylamide hydrogel (PAGH) was introduced and is now widely used as an agent. The objective was to evaluate the efficacy of PAGH based on a national population over a 5-year period (2007–2011) and the influence of patient-related factors, surgeon experience, and department volume.Methods
A retrospective cohort study was carried out based on data from the Danish Urogynaecological Database (DugaBase).Results
A total of 731 women were registered in the DugaBase. Cure was achieved in 75 out of 252 women (29.8%) and no leakage at all in 23 out of 252 (9.1%) at the 3-month follow-up. The mean total International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score decreased from 16 (SD 3.8) to 10.6 (SD 6.2; p?<?0.001). UIT was performed at 16 departments, of which four high-volume departments performed 547 out of 814 UITs (67.2%). Women with severe UI had a decreased chance of cure (all ICIQ-SF scores), as did women on antimuscarinic drugs (adjusted OR 0.14; 95%, CI 0.04–0.41 “frequency”) and (adjusted OR 0.33; 95%, CI 0.13–0.82, “amount”). Women treated by a high-volume surgeon had a higher chance of cure (OR 4.51; 95% CI, 1.21–16.82, “frequency”) and a lower risk of 30-day hospital contacts (OR 0.27; 95% CI 0.09–0.76).Conclusion
The study represented a cure for UIT among women in an everyday life setting. A surgeon learning curve for UIT was indicated, as was assigning interventions to fewer hands to improve the surgical training value and consequently the cure rate for women with UIT.12.
Background and purpose — The effects of launch or closure of an entire arthroplasty unit on the first or last patients treated in these units have not been studied. Using a 3-year follow-up, we investigated whether patients who were treated at the launch or closure stage of an arthroplasty unit of a hospital would have a higher risk of reoperation than patients treated in-between at the same units.Patients and methods — From the Finnish Arthroplasty Register, we identified all the units that had performed total joint arthroplasty and the units that were launched or closed in Finland between 1998 and 2011. The risks of reoperation within 3 years for the 41,748 total hip and knee replacements performed due to osteoarthritis in these units were modeled with Cox proportional-hazards regression, separately for hip and knee and for the launch and the closure stage.Results — The unadjusted and adjusted hazard ratios (HRs) for total hip and knee replacements performed in the initial stage of activity of the units that were launched were similar to the reoperation risks in patients who were operated in these units after the early stage of activity. The unadjusted and risk-adjusted HRs for early reoperation after total hip replacement (THR) were increased at the closure stage (adjusted HR?=?1.8, 95% CI: 1.2–2.8). The reoperation risk at the closure stage after total knee replacement (TKR) was not increased.Interpretation — The results indicate that closure of units performing total hip replacements poses an increased risk of reoperation. Closures need to be managed carefully to prevent the quality from deteriorating when performing the final arthroplasties. 相似文献
13.
Barbara Shih Jason J. Brown Daniel J. Armstrong Tommy Lindau Ardeshir Bayat 《Hand (New York, N.Y.)》2009,4(3):294-301
Dupuytren’s disease (DD) is a benign fibroproliferative tumor with an unknown etiology and high recurrence postsurgery. Several
observations suggest the possible involvement of skin overlying nodule (SON) and the subcutaneous fat in the pathogenesis
of DD. This study aims to (1) compare the gene expression levels of SON and subcutaneous fat in DD and normal subjects and
(2) to compare transverse palmar fascia (Skoog’s fibers) from DD patients as internal control tissue, with palmar fascia (transverse
carpal ligament) from patients undergoing carpal tunnel release as external control. Skin, fat, and fascia were obtained from
five DD patients of Caucasian origin (age = 66 ± 14) and from five control subjects (age = 57 ± 19) undergoing carpal tunnel
release. Total ribonucleic acids was extracted from each sample and used for complementary deoxyribonucleic acid synthesis.
Real-time quantitative polymerase chain reaction was used to assess the gene expression levels of six candidate genes: A disintegrin
and metalloproteinase domain (ADAM12), aldehyde dehydrogenase 1 family member A1 (ALDH1A1), iroquois homeoboxprotein 6 (IRX6),
periostin, osteoblast specific factor, proteoglycan 4, and tenascin C. Using independent t test, ADAM12, ALDH1A1, and IRX6 expression levels in DD fats were significantly (p < 0.05) higher than those in the controls. There is no significant difference in the gene expression levels of all six genes
when comparing disease and control fascia and skin. Interestingly, ADAM12 up-regulation has also been observed in several
other fibrotic and proliferative disorders. In conclusion, this study demonstrates potential roles for subcutaneous fat in
DD pathogenesis as well as supports the use of transverse palmar fascia as appropriate control tissues in DD research. 相似文献
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Angela M. Parcesepe Melissa Stockton Molly Remch C. William Wester Charlotte Bernard Jeremy Ross Andreas D. Haas Rogers Ajeh Keri N. Althoff Leslie Enane William Pape Albert Minga Edith Kwobah Mpho Tlali Junko Tanuma Dominique Nsonde Aimee Freeman Stephany N. Duda Denis Nash Kathryn Lancaster the IeDEA Consortium 《Journal of the International AIDS Society》2023,26(8):e26147
Introduction
Common mental disorders (CMDs) are highly prevalent among people with HIV. Integrating mental healthcare into HIV care may improve mental health and HIV treatment outcomes. We describe the reported availability of screening and treatment for depression, anxiety and post-traumatic stress disorder (PTSD) at global HIV treatment centres participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium in 2020 and changes in availability at sites in low- or middle-income countries (LMICs) between 2016/2017 and 2020.Methods
In 2020, 238 sites contributing individual-level data to the IeDEA Consortium and in 2016/2017 a stratified random sample of IeDEA sites in LMICs were eligible to participate in site surveys on the availability of screening and treatment for CMDs. We assessed trends over time for 68 sites across 27 LMICs that participated in both surveys.Results
Among the 238 sites eligible to participate in the 2020 site survey, 227 (95%) participated, and mental health screening and treatment data were available for 223 (98%) sites across 41 countries. A total of 95 sites across 29 LMICs completed the 2016/2017 survey. In 2020, 68% of sites were in urban settings, and 77% were in LMICs. Overall, 50%, 14% and 12% of sites reported screening with a validated instrument for depression, anxiety and PTSD, respectively. Screening plus treatment in the form of counselling was available for depression, anxiety and PTSD at 46%, 13% and 11% of sites, respectively. Screening plus treatment in the form of medication was available for depression, anxiety and PTSD at 36%, 11% and 8% of sites, respectively. Among sites that participated in both surveys, screening for depression was more commonly available in 2020 than 2016/2017 (75% vs. 59%, respectively, p = 0.048).Conclusions
Reported availability of screening for depression increased among this group of IeDEA sites in LMICs between 2016/2017 and 2020. However, substantial gaps persist in the availability of mental healthcare at HIV treatment sites across global settings, particularly in resource-constrained settings. Implementation of sustainable strategies to integrate mental health services into HIV care is needed. 相似文献17.
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Y. M. Kim S. H. Kim S. Kim J. S. Yoo E. Y. Choe Y. J. Won 《Osteoporosis international》2016,27(8):2543-2554