C-reactive protein levels and survival in patients with moderate to very severe COPD

BACKGROUND: Serum levels of C-reactive protein (CRP) are increased in patients with COPD and correlate modestly with variables predictive of outcomes. In epidemiologic studies, CRP level is associated with all-cause mortality in patients with mild-to-moderate disease. OBJECTIVE: To determine if CRP levels are associated with survival in patients with moderate to very severe COPD in comparison with other well-known prognostic parameters of the disease. METHODS: In 218 stable patients with COPD, we measured baseline serum CRP level, BODE (body mass index, obstruction, dyspnea, and exercise capacity) index and its components, arterial oxygenation (Pao(2)), inspiratory capacity (IC) to total lung capacity (TLC) ratio, and Charlson comorbidity score. We followed up the patients over time and evaluated the strength of the association between the variables and all-cause mortality. RESULTS: During the follow-up time (median, 36 months; 25th to 75th percentiles, 24 to 50 months), 54 patients (25%) died. CRP levels were similar between survivors and the deceased (median, 3.8 mg/L; 95% confidence interval, 1.9 to 8.1; vs median, 4.5 mg/L; 95% confidence interval, 2.1 to 11.5; p = 0.22) and was not significantly associated with survival. CONCLUSIONS: In this population of patients with clinically moderate to very severe COPD, the level of CRP level was not associated with survival compared with other prognostic clinical tools such as the BODE index, modified Medical Research Council scale, 6-min walk distance, percentage of predicted FEV(1), IC/TLC ratio < 0.25, and Pao(2). Other long-term studies of well-characterized patients with COPD could help determine the exact role of CRP levels as a biomarker in patients with clinical COPD.     

Determinants of and changes in catastrophic health expenditure in the occupied Palestinian territory: an analysis of ten rounds of the Palestinian Households Expenditure and Consumptions Survey (1996–2011)

Background

Catastrophic health expenditure (CHE) is measured to assess the financial protection from the risk of health-related conditions, which is considered a principle performance goal of any health system. The incidence and intensity of CHE in the occupied Palestinian territory between 1998 and 2007 was assessed in previous research; however, no research has assessed the occurrence of CHE in different population groups in the occupied Palestinian territory. The objective of this study was to examine the changes in the occurrence of CHE in different groups of Palestinians from 1996 to 2011, which was a period of increasing political turmoil, transformation of the national health system, and economic hardship faced by the population.

Pneumonia in Nigeria: The way forward

Pneumonia is the leading cause of child deaths in Nigeria. Interventions to combat pneumonia are known and globally available, but not yet deployed effectively in Nigeria. While the under‐five pneumonia deaths dropped globally by 51% during the Millennium Development Goals (MDG) years (2000 to 2015), the rate declined by a mere 8% in Nigeria. In this commentary, we focus on three factors that may have stalled Nigeria's progress on pneumonia control. First, a chronically weak health system failed to deliver the needed services at scale. Second, strong coordination of a multipronged and well‐funded push against pneumonia was absent. Third, sound and timely data on pneumonia intervention coverage were lacking, thus blunting the accountability mechanisms that could have driven quick, targeted action. In response, the Federal Ministry of Health recently developed a National Pneumonia Control Strategy with the support of the “Every Breath Counts Coalition” (EBCC). This strategy, a first of its kind, articulates a common vision for reducing pneumonia‐led morbidity and mortality and provides a unified approach to respond comprehensively to pneumonia within and outside the health sector. Strong political will and sustainable financing are now needed to effectively implement this strategy and accelerate progress on pneumonia control. This will contribute hugely to achieving the government's health goals, the Sustainable Development Goal (SDG) 3.2 and the Global Action Plan on Pneumonia and Diarrhoea (GAPPD) targets.     

Diagnostic Accuracy of Global Longitudinal Strain for Detecting Significant Coronary Artery Disease in Diabetic Patients without Regional Wall Motion Abnormality

AimsSpeckle-tracking imaging is a novel method for assessing left ventricular (LV) function and ischemic changes. The aim of this prospective study was to assess the diagnostic accuracy of global longitudinal strain (GLS) and regional longitudinal strain (RLS) parameters at rest in comparison to stress echocardiography findings for detecting significant coronary artery disease (CAD) in patients with diabetes mellitus (DM).MethodsWe prospectively studied echocardiographic characteristics at rest with Speckle tracking echocardiography (2D STE) measures; then stress echocardiography and coronary angiography data in 34 diabetic patients without regional wall motion abnormality (RWMA) at rest. Patients were grouped according to coronary angiography and stress echocardiography results into two groups CAD (+) vs control group CAD (−).ResultsGLS at rest was lower in the CAD (+) group ((-14.2 % ± 3.1 vs -17.8 % ± 3.1 in the control group CAD (−), P=0.004). GLS at rest had the highest area under the ROC curve (AUC) (AUC 0.78, sensitivity 61%, specificity 91%,P=0.009) with the cut-off of -14.5% which is equal to predictive power of wall motion scoring index (WMSI) at peak stress to detect significant CAD (AUC=0.76 (95% CI 0.58–0.94, P= 0.016) with the cut-off value of 1.21).ConclusionsGlobal longitudinal strain at rest by STE showed excellent specificity (>90%) and good sensitivity (60%) for the diagnosis of severe CAD among the diabetic population with unknown CAD. This is the first study showing that GLS at rest with cutoff value at -14.5% had good and equal diagnostic accuracy as WMSI at peak stress to detect significant CAD among the diabetic population.     

Patient safety and communication: A new assessment for doctors trained in countries where language differs from that of the host country: Results of a pilot using a domain-based assessment

Objective

Global migration of healthcare workers places responsibility on employers to comply with legal employment rights whilst ensuring patient safety remains the central goal. We describe the pilot of a communication assessment designed for doctors who trained and communicated with patients and colleagues in a different language from that of the host country. It is unique in assessing clinical communication without assessing knowledge.

Methods

A 14-station OSCE was developed using a domain-based marking scheme, covering professional communication and English language skills (speaking, listening, reading and writing) in routine, acute and emotionally challenging contexts, with patients, carers and healthcare teams. Candidates (n = 43), non-UK trained volunteers applying to the UK Foundation Programme, were provided with relevant station information prior to the exam.

Results

The criteria for passing the test included achieving the pass score and passing 10 or more of the 14 stations. Of the 43 candidates, nine failed on the station criteria. Two failed the pass score and also the station criteria. The Cronbach's alpha coefficient was 0.866.

Conclusion

This pilot tested ‘proof of concept’ of a new domain-based communication assessment for non-UK trained doctors.

Practice implications

The test would enable employers and regulators to verify communication competence and safety in clinical contexts, independent of clinical knowledge, for doctors who trained in a language different from that of the host country.     

Intensity-based image registration using scatter search

ObjectiveWe present a novel intensity-based algorithm for medical image registration (IR).Methods and materialsThe IR problem is formulated as a continuous optimization task, and our work focuses on the development of the optimization component. Our method is designed over an advanced scatter search template, and it uses a combination of restart and dynamic boundary mechanisms integrated within a multi-resolution strategy.ResultsThe experimental validation is performed over two datasets of human brain magnetic resonance imaging. The algorithm is evaluated in both a stand-alone registration application and an atlas-based segmentation process targeted to the deep brain structures, considering a total of 16 and 18 scenarios, respectively. Five established IR techniques, both feature- and intensity-based, are considered for comparison purposes, and ground-truth data is used to quantitatively assess the quality of the results. Our approach ranked first in both studies and it is able to outperform all competitors in 12 of 16 registration scenarios and in 14 of 18 registration-based segmentation tasks. A statistical analysis confirms with high confidence (p < 0.014) the accuracy and applicability of our method.ConclusionsWith a proper, problem-specific design, scatter search is able to provide a robust, global optimization. The accuracy and reliability of the registration process are superior to those of classic gradient-based techniques.