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Mark W. Lingen Malavika P. Tampi Olivia Urquhart Elliot Abt Nishant Agrawal Anil K. Chaturvedi Ezra Cohen Gypsyamber D’Souza JoAnn Gurenlian John R. Kalmar Alexander R. Kerr Paul M. Lambert Lauren L. Patton Thomas P. Sollecito Edmond Truelove Laura Banfield Alonso Carrasco-Labra 《Journal of the American Dental Association (1939)》2017,148(11):797-813.e52
Background
Oral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients’ values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity.Types of Studies Reviewed
The authors searched for preexisting systematic reviews and assessed their quality using the Assessing the Methodological Quality of Systematic Reviews tool. The authors updated the selected reviews and searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and DTA and PVPs studies. Pairs of reviewers independently conducted study selection, data extraction, and assessment of the certainty in the evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach.Results
The authors identified 4 existing reviews. DTA reviews included 37 studies. The authors retrieved 7,534 records, of which 9 DTA and 10 PVPs studies were eligible. Pooled sensitivity and specificity of adjuncts ranged from 0.39 to 0.96 for the evaluation of innocuous lesions and from 0.31 to 0.95 for the evaluation of suspicious lesions. Cytologic testing used in suspicious lesions appears to have the highest accuracy among adjuncts (sensitivity, 0.92; 95% confidence interval, 0.86 to 0.98; specificity, 0.94; 95% confidence interval, 0.88 to 0.99; low-quality evidence).Conclusions and Practical Implications
Cytologic testing appears to be the most accurate adjunct among those included in this review. The main concerns are the high rate of false-positive results and serious issues of risk of bias and indirectness of the evidence. Clinicians should remain skeptical about the potential benefit of any adjunct in clinical practice. 相似文献44.
V Devi K Ramnarayan RR Abraham V Pallath A Kamath S Kodidela 《Journal of postgraduate medicine》2015,61(3):163-168
Background:
Participation in research during undergraduate studies may increase students’ interest in research and inculcate research essentials in them.Aims:
The purpose of this study was to evaluate the effectiveness of the mentored student project (MSP) program.Settings and Design:
In the MSP program, students in groups (n = 3 to 5) undertook a research project, wrote a scholarly report, and presented the work as a poster presentation with the help of a faculty mentor. To begin with, the logic model of the program was developed to identify short-term outcomes of the program on students, mentors, and the institution. A quasi-experimental design was used to measure the outcomes.Materials and Methods:
A mixed method evaluation was done using a newly-developed questionnaire to assess the impact of the MSP on students’ attitude, a multiple-choice question (MCQs) test to find out the impact on students’ knowledge and grading of students’ project reports and posters along with a survey to check the impact on skills. Students’ satisfaction regarding the program and mentors’ perceptions were collected using questionnaires. Evidence for validity was collected for all the instruments used for the evaluation.Statistical Analysis:
Non-parametric tests were used to analyze data. Based on the scores, project reports and posters were graded into A (>70% marks), B (60-69% marks), and C (<59% marks) categories. The number of MSPs that resulted in publications, conference presentation and departmental collaborations were taken as impact on the institution.Results:
Students’ response rate was 91.5%. The students’ attitudes regarding research changed positively (P = 0.036) and score in the MCQ test improved (P < 0.001) after undertaking MSP. Majority of project reports and posters were of grade A category. The majority of the items related to skills gained and satisfaction had a median score of 4. The MSPs resulted in inter-departmental and inter-institutional collaborations, 14 publications and 15 conference presentations. An area for improvement noted was to have the MSP implemented in the curriculum without increasing students’ overall workload and stress.Conclusion:
The study identified strengths and weaknesses of the MSP program. Our model of undergraduate research project may be incorporated in undergraduate medical programs to foster positive attitude and knowledge base about scientific research and to instil research skills among students.KEY WORDS: Attitude, knowledge, mentored, outcome, research, skills, student 相似文献45.
46.
Chandralekha Tampi 《The Indian journal of surgery》2012,74(1):67-72
Optimal care of a patient implies a good professional understanding between all the medical personnel involved in that patient’s
care. Similarly a basic understanding of the areas where surgery and pathology interact would go a long way, in clarifying
the disease process in the patient. This review aims to cover a few topics in liver lesions, FNAC Vs core biopsy, IHC, Margin
examination, and frozen sections, in order to improve the communication between these two specialities. 相似文献
47.
RR Klont CA Eggink AJ Rijs P Wesseling PE Verweij 《Clinical infectious diseases》2005,40(12):e110-e112
A case of invasive Fusarium keratitis in a previously healthy male patient was treated successfully with cornea transplantation and systemic and topical voriconazole after treatment failure with topical amphotericin B and systemic itraconazole. Topical voriconazole was well tolerated, and, in conjunction with the oral administration, it resulted in a high level of the drug in the anterior chamber of the eye (which was 160% of the plasma drug level). 相似文献
48.
Defective opsonization in multiple myeloma 总被引:1,自引:0,他引:1
The mechanisms responsible for the unusual susceptibility of multiple myeloma (MM) patients to infections are incompletely defined. Since MM is associated with decreased production of normal serum proteins, we investigated the possibility that the production of opsonins might also be impaired. The neutrophil chemiluminescence assay of opsonization was used to evaluate the ability of serum from patients with MM to opsonize zymosan. It was found that sera from 18 MM patients exerted only 50% +/- 2.5% (mean +/- SEM) of the opsonic activity found in 18 control sera (p less than 0.001). In mixture experiments, untreated normal serum completely restored the opsonic activity of MM serum, suggesting a deficiency of opsonic factors rather than an inhibitor. In other mixture experiments, heat-inactivated normal serum only partially corrected the opsonic defect in MM serum. Serum from three patients had low C3 levels, and treatment of particles with these resulted in a greater opsonic defect than the patient population as a whole (p less than 0.02). No correlation between the opsonic defect and infections was established over an 18-mo period. These data suggest that MM serum lacks both heat-stable and heat-labile opsonic activity, the direct clinical significance of which remains to be clarified. However, these studies support the concept that defective host resistance in MM may be multifactoral, combining opsonic abnormalities with other defects previously described. 相似文献
49.
大肠癌免疫组化表达与临床病理的关系 总被引:1,自引:0,他引:1
目的:探讨大肠癌CEA、P53、nm23、Ki-67、MRP免疫组化表达特点和相互关系,及其与临床病理的关系.方法:回顾性分析2003-01/2006-07我院收治的73例大肠癌患者的临床病理及随访资料,并对其石蜡标本采用免疫组化SP染色法检测CEA、P53、nm23、Ki-67、MRP,分析其免疫组化特点及其与临床病理之间的关系.结果:CEA、P53、nm23、Ki-67、MRP在大肠癌中的阳性表达率依次为82.2%、68.5%、75.3%、84.9%和64.4%.CEA、MRP与大肠癌患者的各因素无统计学差异.P53、Ki-67和nm23与肿瘤的Dukes分期和淋巴结转移有关, P53、Ki-67在Dukes C、D期的阳性表达率(依次为82.8%和100%1明显高于Dukes A、B期者(59.1%和75.0%)(P<0.05),而nm23在Dukes C、D期的阳性表达率(58.6%)明显低于Dukes A、B期者(86.4%)(P<0.05).CEA与nm23的表达呈明显的负相关(r=-0.296,P=0.011),而P53和Ki-67表达之间呈现明显的正相关(r= 0.308,P=0.008),其他各指标间的表达无相关性.nm23、P53和Ki-67与预后因素关系明显,nm23在生存期≥3 a患者的阳性表达率(92.9%)高于生存期<3 a者(71.2%)(P<0.05),而P53和Ki-67在生存期≥3 a患者的阳性表达率(依次为42.9%和64.3%)明显低于生存期<3 a者(74.6%和89.8%)(P<0.05).结论:P53、Ki-67和nm23的表达与大肠癌的侵袭转移和预后密切相关.CEA可能是大肠癌的侵袭转移的促进因素.MRP所引起的耐药机制是一个相对独立的机制.CEA、P53、nm23、Ki-67可作为判断大肠癌恶性程度、侵袭转移以及预后的指标. 相似文献
50.