Impact of statistical reconstruction and compressed sensing algorithms on projection data elimination during X-ray CT image reconstruction

Abstract

Objectives

To examine the effect of incomplete, or total elimination of, projection data on computed tomography (CT) images subjected to statistical reconstruction and/or compressed sensing algorithms.

Methods

Multidetector row CT images were used. The algebraic reconstruction technique (ART) and the maximum likelihood-expectation maximization (ML-EM) method were compared with filtered back-projection (FBP). Effects on reconstructed images were studied when the projection data of 360° (360 projections) were decreased to 180 or 90 projections by reducing the collection angle or thinning the image data. The total variation (TV) regularization method using compressed sensing was applied to images processed by the ART. Image noise was subjectively evaluated using the root-mean-square error and signal-to-noise ratio.

Results

When projection data were reduced by one-half or three-quarters, ART and ML-EM produced better image quality than FBP. Both ART and ML-EM resulted in high quality at a spread of 90 projections over 180° rotation. Computational loading was high for statistical reconstruction, but not for ML-EM, compared with the ART. TV regularization made it possible to use only 36 projections while still achieving acceptable image quality.

Conclusions

Incomplete projection data—accomplished by reducing the angle to collect image data or thinning the projection data without reducing the angle of rotation over which it is collected—made it possible to reduce the radiation dose while retaining image quality with statistical reconstruction algorithms and/or compressed sensing. Despite heavier computational calculation loading, these methods should be considered for reducing radiation doses.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2AAswAn

Spectrobiopsy in neurodiagnostics: the new era

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2AyWULr

Spectrobiopsy in neurodiagnostics: the new era

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2AyWULr

Benefit of using motion compensated reconstructions for reducing inter-observer and intra-observer contouring variation for organs at risk in lung cancer patients

In lung cancer patients, accuracy in contouring is hampered by image artefacts introduced by respiratory motion. With the widespread introduction of 4DCT there is additional uncertainty caused by the use of different reconstruction techniques which will influence contour definition. This work aims to assess both inter- and intra-observer contour variation on average and motion compensated (mid-position) reconstructions.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2inO1Ml

Extraction and quantification system for environmental radioxenon sample analysis

Publication date: February 2018
Source:Journal of Environmental Radioactivity, Volume 182
Author(s): M. Sabzian, M.N. Nasrabadi, M. Haji-Hosseini
A xenon dynamic adsorption setup based on granular activated carbon packed column was developed. The adsorption behavior of xenon under different experimental conditions was studied and the results used to design an appropriate adsorber column for specific conditions. The resulting radioxenon gas extraction and quantification setup was evaluated based on an inter-comparison exercise and standard sample analysis results. The results showed that the quantification setup achieves experimental rules with uncertainty of ±3%.



from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2BHoia1

Improving CT detection sensitivity for nodal metastases in oesophageal cancer with combination of smaller size and lymph node axial ratio

Abstract

Objectives

To investigate the value of CT with inclusion of smaller lymph node (LN) sizes and axial ratio to improve the sensitivity in diagnosis of regional lymph node metastases in oesophageal squamous cell carcinoma (OSCC).

Methods

The contrast-enhanced multidetector row spiral CT (MDCT) multiplanar reconstruction images of 204 patients with OSCC were retrospectively analysed. The long-axis and short-axis diameters of the regional LNs were measured and axial ratios were calculated (short-axis/long-axis diameters). Nodes were considered round if the axial ratio exceeded the optimal LN axial ratio, which was determined by receiver operating characteristic analysis.

Results

A positive predictive value (PPV) exceeding 50% is needed. This was achieved only with LNs larger than 9 mm in short-axis diameter, but nodes of this size were rare (sensitivity 37.3%, specificity 96.4%, accuracy 85.8%). If those round nodes (axial ratio exceeding 0.66 ) between 7 mm and 9 mm in size were considered metastases as well, it might improve the sensitivity to 67.2% with a PPV of 63.9% (specificity 91.6%, accuracy 87.2%).

Conclusion

Combination of a smaller size and axial ratio for LNs in MDCT as criteria improves the detection sensitivity for LN metastases in OSCC.

Key Points

• CT is widely used to assess metastatic lymph nodes.

• CT has low sensitivity in detecting metastases using conventional criteria.

• Diagnostic sensitivity of CT was improved by using lymph node axial ratio.

• New diagnostic criteria provide greater diagnostic confidence with PPVs exceeding 50%.

• New diagnostic criteria may help clinicians assess patients with oesophageal cancer.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2jUygg6

High resolution post-mortem MRI of non-fixed in situ foetal brain in the second trimester of gestation: Normal foetal brain development

Abstract

Purpose

To describe normal foetal brain development with high resolution post-mortem MRI (PMMRI) of non-fixed foetal brains.

Methods

We retrospectively collected PMMRIs of foetuses without intracranial abnormalities and chromosomal aberrations studied after a termination of pregnancy due to extracranial abnormalities or after a spontaneous intrauterine death. PMMRIs were performed on a 3-T scanner without any fixation and without removing the brain from the skull. All PMMRIs were evaluated in consensus by two neuroradiologists.

Results

Our analysis included ten PMMRIs (median gestational age (GA): 21 weeks; range: 17–28 weeks). At 19 and 20 weeks of GA, the corticospinal tracts are recognisable in the medulla oblongata, becoming less visible from 21 weeks. Prior to 20 weeks the posterior limb of the internal capsule (PLIC) is more hypointense than surrounding deep grey nuclei; starting from 21 weeks the PLIC becomes isointense, and is hyperintense at 28 weeks. From 19–22 weeks, the cerebral hemispheres show transient layers: marginal zone, cortical plate, subplate, and intermediate, subventricular and germinal zones.

Conclusion

PMMRI of non-fixed in situ foetal brains preserves the natural tissue contrast and skull integrity. We assessed foetal brain development in a small cohort of foetuses, focusing on 19–22 weeks of gestation.

Key Points

• Post-mortem magnetic resonance imaging (PMMRI) of non-fixed head is feasible.

• PMMRI of unfixed in situ foetal brains preserves the natural tissue contrast.

• PMMRI provide a good depiction of the normal foetal brain development.

• PMMRI of unfixed in situ foetal brains preserves the skull integrity.

• PMMRI pattern of foetal brain development at early gestational age is described.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2io4z6L

Revised PROPELLER for T2-weighted imaging of the prostate at 3 Tesla: impact on lesion detection and PI-RADS classification

Abstract

Purpose

To evaluate revised PROPELLER (RevPROP) for T2-weighted imaging (T2WI) of the prostate as a substitute for turbo spin echo (TSE).

Materials and methods

Three-Tesla MR images of 50 patients with 55 cancer-suspicious lesions were prospectively evaluated. Findings were correlated with histopathology after MRI-guided biopsy. T2 RevPROP, T2 TSE, diffusion-weighted imaging, dynamic contrast enhancement, and MR-spectroscopy were acquired. RevPROP was compared to TSE concerning PI-RADS scores, lesion size, lesion signal-intensity, lesion contrast, artefacts, and image quality.

Results

There were 41 carcinomas in 55 cancer-suspicious lesions. RevPROP detected 41 of 41 carcinomas (100%) and 54 of 55 lesions (98.2%). TSE detected 39 of 41 carcinomas (95.1%) and 51 of 55 lesions (92.7%). RevPROP showed fewer artefacts and higher image quality (each p < 0.001). No differences were observed between single and overall PI-RADS scores based on RevPROP or TSE (p = 0.106 and p = 0.107). Lesion size was not different (p = 0.105). T2-signal intensity of lesions was higher and T2-contrast of lesions was lower on RevPROP (each p < 0.001).

Conclusion

For prostate cancer detection RevPROP is superior to TSE with respect to motion robustness, image quality and detection rates of lesions. Therefore, RevPROP might be used as a substitute for T2WI.

Key points

• Revised PROPELLER can be used as a substitute for T2-weighted prostate imaging.

• Revised PROPELLER detected more carcinomas and more suspicious lesions than TSE.

• Revised PROPELLER showed fewer artefacts and better image quality compared to TSE.

• There were no significant differences in PI-RADS scores between revised PROPELLER and TSE.

• The lower T2-contrast of revised PROPELLER did not impair its diagnostic quality.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2jT5sF0

Noninvasive electrical conductivity measurement by MRI: a test of its validity and the electrical conductivity characteristics of glioma

Abstract

Objectives

This study noninvasively examined the electrical conductivity (σ) characteristics of diffuse gliomas using MRI and tested its validity.

Methods

MRI including a 3D steady-state free precession (3D SSFP) sequence was performed on 30 glioma patients. The σ maps were reconstructed from the phase images of the 3D SSFP sequence. The σ histogram metrics were extracted and compared among the contrast-enhanced (CET) and noncontrast-enhanced tumour components (NCET) and normal brain parenchyma (NP). Difference in tumour σ histogram metrics among tumour grades and correlation of σ metrics with tumour grades were tested. Validity of σ measurement using this technique was tested by correlating the mean tumour σ values measured using MRI with those measured ex vivo using a dielectric probe.

Results

Several σ histogram metrics of CET and NCET of diffuse gliomas were significantly higher than NP (Bonferroni-corrected p ≤ .045). The maximum σ of NCET showed a moderate positive correlation with tumour grade (r = .571, Bonferroni-corrected p = .018). The mean tumour σ measured using MRI showed a moderate positive correlation with the σ measured ex vivo (r = .518, p = .040).

Conclusions

Tissue σ can be evaluated using MRI, incorporation of which may better characterise diffuse gliomas.

Key Points

• This study tested the validity of noninvasive electrical conductivity measurements by MRI.

• This study also evaluated the electrical conductivity characteristics of diffuse glioma.

• Gliomas have higher electrical conductivity values than the normal brain parenchyma.

• Noninvasive electrical conductivity measurement can be helpful for better characterisation of glioma.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2injWfI

Ultrasound-guided percutaneous bone drilling for the treatment of lateral epicondylitis

Abstract

Objective

To determine the clinical efficacy of sonographically-guided percutaneous bone drilling of the lateral epicondyle (LE) for the treatment of patients with LE.

Methods

We included 24 patients with LE who reported pain in this study. All patients underwent sonographically-guided percutaneous bone drilling of the lateral epicondyle. Follow-up sonography and physical examinations were performed 1, 3 and 6 months after the procedure. The outcome measures included sonographic findings, visual analogue scale (VAS) score, maximum voluntary grip strength (MVGS) and patient-related tennis elbow evaluation (PRTEE) score.

Results

None of the patients had immediate complications during the procedure. The area of the extensor carpi radialis brevis (ECRB) tears decreased significantly at 1 month and declined gradually over the remaining 5 months of the study (p < 0.001). The mean pain VAS score was significantly lower at 6 months than preoperatively (respectively; p < 0.001). The mean MVGS increased significantly between pretreatment and 6 months post-treatment (p < 0.001), whereas the PRTEE score decreased significantly during the same period (p < 0.001).

Conclusion

Sonographically-guided percutaneous drilling is a quick and safe treatment option for LE that can be performed in an outpatient setting.

Key Points

• Percutaneous drilling of the lateral condyle is effective for the treatment of LE.

• The area of ECRB tears can be measured by US-guided saline injection.

• US-guided percutaneous drilling is a quick and safe treatment option for LE.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2jSXThB

Software-based risk stratification of pulmonary adenocarcinomas manifesting as pure ground glass nodules on computed tomography

Abstract

Objectives

To assess the performance of the "Computer-Aided Nodule Assessment and Risk Yield" (CANARY) software in the differentiation and risk assessment of histological subtypes of lung adenocarcinomas manifesting as pure ground glass nodules on computed tomography (CT).

Methods

64 surgically resected and histologically proven adenocarcinomas manifesting as pure ground-glass nodules on CT were assessed using CANARY software, which classifies voxel-densities into three risk components (low, intermediate, and high risk). Differences in risk components between histological adenocarcinoma subtypes were analysed. To determine the optimal threshold reflecting the presence of an invasive focus, sensitivity, specificity, negative predictive value, and positive predictive value were calculated.

Results

28/64 (44%) were adenocarcinomas in situ (AIS); 26/64 (41%) were minimally invasive adenocarcinomas (MIA); and 10/64 (16%) were invasive ACs (IAC). The software showed significant differences in risk components between histological subtypes (P<0.001–0.003). A relative volume of 45% or less of low-risk components was associated with histological invasiveness (specificity 100%, positive predictive value 100%).

Conclusions

CANARY-based risk assessment of ACs manifesting as pure ground glass nodules on CT allows the differentiation of their histological subtypes. A threshold of 45% of low-risk components reflects invasiveness in these groups.

Key points

• CANARY-based risk assessment allows the differentiation of their histological subtypes.

• 45% or less of low-risk component reflects histological invasiveness.

• CANARY has potential role in suspected adenocarcinomas manifesting as pure ground-glass nodules.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2iqqcUj

The effect of iodine uptake on radiation dose absorbed by patient tissues in contrast enhanced CT imaging: Implications for CT dosimetry

Abstract

Objectives

To investigate the effect of iodine uptake on tissue/organ absorbed doses from CT exposure and its implications in CT dosimetry.

Methods

The contrast-induced CT number increase of several radiosensitive tissues was retrospectively determined in 120 CT examinations involving both non-enhanced and contrast-enhanced CT imaging. CT images of a phantom containing aqueous solutions of varying iodine concentration were obtained. Plots of the CT number increase against iodine concentration were produced. The clinically occurring iodine tissue uptake was quantified by attributing recorded CT number increase to a certain concentration of aqueous iodine solution. Clinically occurring iodine uptake was represented in mathematical anthropomorphic phantoms. Standard 120 kV CT exposures were simulated using Monte Carlo methods and resulting organ doses were derived for non-enhanced and iodine contrast-enhanced CT imaging.

Results

The mean iodine uptake range during contrast-enhanced CT imaging was found to be 0.02-0.46% w/w for the investigated tissues, while the maximum value recorded was 0.82% w/w. For the same CT exposure, iodinated tissues were found to receive higher radiation dose than non-iodinated tissues, with dose increase exceeding 100% for tissues with high iodine uptake.

Conclusions

Administration of iodinated contrast medium considerably increases radiation dose to tissues from CT exposure.

Key-points

• Radiation absorption ability of organs/tissues is considerably affected by iodine uptake

• Iodinated organ/tissues may absorb up to 100 % higher radiation dose

• Compared to non-enhanced, contrast-enhanced CT may deliver higher dose to patient tissues

• CT dosimetry of contrast-enhanced CT imaging should encounter tissue iodine uptake

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2jV87xU

Improving mTICI2b reperfusion to mTICI2c/3 reperfusions: A retrospective observational study assessing technical feasibility, safety and clinical efficacy

Abstract

Background

Recent studies suggested that modified Thrombolysis in Cerebral Infarction grade (mTICI) 3 reperfusions are associated with superior outcome to mTICI2b reperfusions, questioning if neurointerventionalists should generally strive to achieve mTICI3.

Methods

Retrospective analysis of successfully reperfused MCA occlusions (n=246) with available angiography runs between every manoeuvre was performed. Final reperfusion success and those between all single manoeuvres were evaluated applying the modified version of the TICI score (including TICI2c). Final TICI2c/3 reperfusions were dichotomized as 'direct' (reperfusion before final manoeuvre ≤mTICI2a) or 'secondary improved' (mTICI2b was achieved).

Results

Patients with mTICI2c reperfusion had similar outcome to patients with mTICI3 rather than mTICI2b reperfusions. Compared with mTICI2c/3-patients, mTICI2b-patients had lower rates of neurological improvement (33.3% vs. 61.2%, p<0.001) and good functional outcome (28.7% vs. 46.5%, p=0.008). In 28 patients, mTICI2b reperfusion was improved to mTICI2c/3 without complications. Outcome of patients with 'direct' or 'secondary improved' mTICI2c/3 did not differ (p>0.5).

Conclusion

Improving mTICI2b reperfusions to mTICI2c/3 reperfusions is sometimes technically feasible and safe, and associated with clinical benefit comparable to 'direct' mTICI2c/3 reperfusions. If confirmed, a more aggressive treatment approach in cases of already achieved mTICI2b may be justified, although proper patient selection is needed.

Key Points

• Patients with mTICI2c or 3 reperfusions have a comparable clinical course.

• mTICI2c/3 are associated with a larger therapeutic benefit than are mTICI2b reperfusions.

• Improving reperfusion from mTICI2b to mTICI2c/3 is sometimes feasible and reasonably safe.

• Outcome of patients with 'secondary improved' and 'direct' mTICI2c/3 is not different.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2ireYP3

Bone marrow oedema predicts bone collapse in paediatric and adolescent leukaemia patients with corticosteroid-induced osteonecrosis

Abstract

Objectives

Corticosteroid treatment of paediatric leukaemia patients can lead to osteonecrosis (ON). We determined whether bone marrow oedema (BME) is an early sign of progressive ON and eventual bone collapse.

Methods

In a retrospective study, two radiologists reviewed MR imaging characteristics of 47 early stage epiphyseal ON in 15 paediatric and adolescent leukaemia patients. Associations between BME on initial imaging studies and subchondral fracture, disease progression and bone collapse were assessed by Cochran-Mantel-Haenszel tests. Differences in time to progression and bone collapse between lesions with and without oedema were assessed by log rank tests.

Results

Forty-seven occurrences of ON were located in weight bearing joints, with 77% occurring in the femur. Seventeen lesions progressed to collapse, two lesions worsened without collapse, and 28 remained stable or improved. BME was significantly associated with subchondral fracture (p = 0.0014), disease progression (p = 0.0015), and bone collapse (p < 0.001), with a sensitivity and specificity of 94% and 77%, respectively, for bone collapse. Time to progression for ON with oedema was 2.7 years (95% CI: 1.7-3.4); while the majority of no-oedema ON were stable (p = 0.0011).

Conclusions

BME is an early sign of progressive ON and eventual bone collapse in paediatric and adolescent leukaemia patients.

Key points

• Bone marrow oedema in corticosteroid-induced osteonecrosis predicts progression to bone collapse.

• Bone marrow oedema is associated with subchondral fractures in corticosteroid-induced osteonecrosis.

• Bone marrow oedema can be used to stratify patients to joint-preserving interventions.

• Absence of bone marrow oedema can justify a "wait and watch" approach.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2jUCDrJ

Longitudinal study of sodium MRI of articular cartilage in patients with knee osteoarthritis: initial experience with 16-month follow-up

Abstract

Objectives

To evaluate the potential of sodium MRI to detect changes over time of apparent sodium concentration (ASC) in articular cartilage in patients with knee osteoarthritis (OA).

Methods

The cartilage of 12 patients with knee OA were scanned twice over a period of approximately 16 months with two sodium MRI sequences at 7 T: without fluid suppression (radial 3D) and with fluid suppression by adiabatic inversion recovery (IR). Changes between baseline and follow-up of mean and standard deviation of ASC (in mM), and their rate of change (in mM/day), were measured in the patellar, femorotibial medial and lateral cartilage regions for each subject. A matched-pair Wilcoxon signed rank test was used to assess significance of the changes.

Results

Changes in mean and in standard deviation of ASC, and in their respective rate of change over time, were only statistically different when data was acquired with the fluid-suppressed sequence. A significant decrease (p = 0.001) of approximately 70 mM in mean ASC was measured between the two IR scans.

Conclusion

Quantitative sodium MRI with fluid suppression by adiabatic IR at 7 T has the potential to detect a decrease of ASC over time in articular cartilage of patients with knee osteoarthritis.

Key Points

• Sodium MRI can detect apparent sodium concentration (ASC) in cartilage

• Longitudinal study: sodium MRI can detect changes in ASC over time

• Potential for follow-up studies of cartilage degradation in knee osteoarthritis

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2iphuFL

What are the differentiating clinical and MRI-features of enchondromas from low-grade chondrosarcomas?

Abstract

Objectives

To evaluate the role of clinical assessment, conventional and dynamic contrast-enhanced MRI in differentiating enchondromas from chondrosarcomas of long bone.

Methods

The following clinical and MRI findings were assessed: age, gender, pain, pain attributable to lesion, tumour location, tumour length, presence, depth of endosteal scalloping, bone marrow oedema, soft tissue oedema, cortical destruction, periosteal reaction, bone expansion, macroscopic fat, calcification, soft tissue mass, haemorrhage, dynamic contrast-enhanced MRI. Clinical and MRI findings were compared with histopathological grading.

Results

Sixty patients with central chondroid tumours were included (27 enchondromas, 10 cartilaginous lesions of unknown malignant potential, 15 grade 1 chondrosarcomas, 8 high-grade chondrosarcomas). Pain attributed to lesion, tumour length, endosteal scalloping > 2/3, cortical destruction, bone expansion and soft tissue mass were differentiating features between enchondromas and grade 1 chondrosarcomas. Dynamic contrast-enhanced MRI could not differentiate enchondromas from grade 1 chondrosarcomas.

Conclusions

Previously reported imaging signs of chondrosarcomas are useful in the diagnosis of grade 1 lesions but have lower sensitivity than in higher grade lesions. Deep endosteal scalloping is the most sensitive imaging sign of grade 1 chondrosarcomas. Pain due to the lesion is an important clinical sign of grade 1 chondrosarcomas. Dynamic contrast-enhanced MRI is not useful in differentiating enchondromas from grade 1 chondrosarcomas.

Key Points

• Differentiation of enchondroma from low-grade chondrosarcoma is challenging for radiologists and pathologists.

• The utility of clinical assessment, conventional and dynamic contrast-enhanced MRI was uncertain.

• Clinical assessment and conventional MRI aid in differentiating enchondromas from low-grade chondrosarcoma.

• Dynamic contrast-enhanced MRI cannot differentiate enchondromas from grade 1 chondrosarcoma.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2jUHdGj

Development of a reliable simulation-based test for diagnostic abdominal ultrasound with a pass/fail standard usable for mastery learning

Abstract

Background

This study aimed to develop a test with validity evidence for abdominal diagnostic ultrasound with a pass/fail-standard to facilitate mastery learning.

Method

The simulator had 150 real-life patient abdominal scans of which 15 cases with 44 findings were selected, representing level 1 from The European Federation of Societies for Ultrasound in Medicine and Biology. Four groups of experience levels were constructed: Novices (medical students), trainees (first-year radiology residents), intermediates (third- to fourth-year radiology residents) and advanced (physicians with ultrasound fellowship). Participants were tested in a standardized setup and scored by two blinded reviewers prior to an item analysis.

Results

The item analysis excluded 14 diagnoses. Both internal consistency (Cronbach's alpha 0.96) and inter-rater reliability (0.99) were good and there were statistically significant differences (p < 0.001) between all four groups, except the intermediate and advanced groups (p = 1.0). There was a statistically significant correlation between experience and test scores (Pearson's r = 0.82, p < 0.001). The pass/fail-standard failed all novices (no false positives) and passed all advanced (no false negatives). All intermediate participants and six out of 14 trainees passed.

Conclusion

We developed a test for diagnostic abdominal ultrasound with solid validity evidence and a pass/fail-standard without any false-positive or false-negative scores.

Key Points

• Ultrasound training can benefit from competency-based education based on reliable tests.

• This simulation-based test can differentiate between competency levels of ultrasound examiners.

• This test is suitable for competency-based education, e.g. mastery learning.

• We provide a pass/fail standard without false-negative or false-positive scores.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2irv4IR

Structured reports of videofluoroscopic swallowing studies have the potential to improve overall report quality compared to free text reports

Abstract

Purpose

To compare free text (FTR) and structured reports (SR) of videofluoroscopic swallowing studies (VFSS) and evaluate satisfaction of referring otolaryngologists and speech therapists.

Materials and methods

Both standard FTR and SR of 26 patients with VFSS were acquired. A dedicated template focusing on oropharyngeal phases was created for SR using online software with clickable decision-trees and concomitant generation of semantically structured reports. All reports were evaluated regarding overall quality and content, information extraction and clinical decision support (10-point Likert scale (0 = I completely disagree, 10 = I completely agree)).

Results

Two otorhinolaryngologists and two speech therapists evaluated FTR and SR. SR received better ratings than FTR in all items. SR were perceived to contain more details on the swallowing phases (median rating: 10 vs. 5; P < 0.001), penetration and aspiration (10 vs. 5; P < 0.001) and facilitated information extraction compared to FTR (10 vs. 4; P < 0.001). Overall quality was rated significantly higher in SR than FTR (P < 0.001).

Conclusion

SR of VFSS provide more detailed information and facilitate information extraction. SR better assist in clinical decision-making, might enhance the quality of the report and, thus, are recommended for the evaluation of VFSS.

Key Points

• Structured reports on videofluoroscopic exams of deglutition lead to improved report quality.

• Information extraction is facilitated when using structured reports based on decision trees.

• Template-based reports add more value to clinical decision-making than free text reports.

• Structured reports receive better ratings by speech therapists and otolaryngologists.

• Structured reports on videofluoroscopic exams may improve the comparability between exams.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2jS21OM

A Systematic Comparative Evaluation of 68 Ga-Labeled RGD Peptides Conjugated with Different Chelators

Abstract

Purpose

The present paper reports a systematic study on the effect of bifunctional chelators (BFC) namely, NOTA, DOTA, and DTPA, on the radiochemical formulation, in vitro stability, and in vivo biological properties of ⁶⁸Ga-labeled RGD peptide derivatives.

Methods

The three RGD conjugates namely, NOTA-Bn-E-[c(RGDfk)]₂, DOTA-Bn-E-[c(RGDfk)]₂, and DTPA-Bn-E-[c(RGDfk)]₂ were radiolabeled with ⁶⁸Ga and the radiolabeling was optimized with respect to the ligand amount, radiolabeling time, and temperature. Further, the ⁶⁸Ga complexes were assessed for their in vitro and in vivo stabilities. The biodistribution studies of the three radiolabeled conjugates were carried out in C57BL/6 mice bearing melanoma tumor at 30 min and 1 h post-adimistration.

Results

NOTA-Bn-E-[c(RGDfk)]₂ could be radiolabeled with ⁶⁸Ga at room temperature while DOTA-Bn-E-[c(RGDfk)]₂ and DTPA-Bn-E-[c(RGDfk)]₂ were radiolabeled at high temperature. ⁶⁸Ga-NOTA-Bn-E-[c(RGDfk)]₂ was found to be the most kinetically rigid in in vitro stability assay. The uptake of the three radiolabeled peptide conjugates in melanoma tumor was comparable at 1 h post-administration (NOTA; DOTA; DTPA (% I.D./g):: 2.78 ± 0.38; 3.08 ± 1.1; 3.36 ± 0.49). However, the tumor/background ratio of ⁶⁸Ga-NOTA-Bn-E-[c(RGDfk)]₂ was the best amongst the three radiotracers. ⁶⁸Ga-complexes of NOTA-Bn-E-[c(RGDfk)]₂ and DOTA-Bn-E-[c(RGDfk)]₂ showed excellent in vivo stability while ⁶⁸Ga-DTPA-Bn-E-[c(RGDfk)]₂ showed significant metabolic degradation.

Conclusion

These studies show that ⁶⁸Ga-NOTA-Bn-E-[c(RGDfk)]₂ would be the most appropriate ⁶⁸Ga-labeled radiotracer and the most amenable for kit formulation.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2BJf2Cd

Complete multinuclear solid-state NMR of metal-organic frameworks: The case of α-Mg-formate

Abstract

Metal-organic frameworks (MOFs) are exciting porous materials with a growing number of applications ranging from catalysis to gas storage. Establishing logical connections between the local MOF structure and its properties is not often straightforward, however, solid-state NMR is a sensitive probe of local structure and can be used to shed light on processes such as guest adsorption and gas motion within MOFs. As illustrated using our recent works on the microporous α-Mg-formate (Mg₃(HCOO)₆) MOF, complete multinuclear solid-state NMR characterization of MOFs is now possible, and can provide unique insight that is not readily available through other methods. A wide variety of solid-state NMR techniques have been employed, including direct-excitation, cross-polarization, fast magic-angle spinning, and two-dimensional experiments. New variable-temperature ²H solid-state NMR data of deuterated hydrogen gas within α-Mg-formate and the resulting detailed dynamic information is also presented, analyzed, and discussed.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2AVj5he

Author's Reply.

Author's Reply.

Diagn Interv Radiol. 2017 Nov 30;:

Authors: Gui B

PMID: 29199175 [PubMed - as supplied by publisher]

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2iUN8Pq

Endometrioma of the sigmoid colon presenting with intestinal obstruction.

Endometrioma of the sigmoid colon presenting with intestinal obstruction.

Diagn Interv Radiol. 2017 Nov 30;:

Authors: Demir MK, Orug T, Bayık RN

PMID: 29199174 [PubMed - as supplied by publisher]

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2AUBpaB

Hemodynamics of Focal Versus Global Growth of Small Cerebral Aneurysms

Abstract

Background and Purpose

Hemodynamics play a driving role in the life cycle of brain aneurysms from initiation through growth until eventual rupture. The specific factors behind aneurysm growth, especially in small aneurysms, are not well elucidated. The goal of this study was to differentiate focal versus general growth and to analyze the hemodynamic microenvironment at the sites of enlargement in small cerebral aneurysms.

Materials and Methods

Small aneurysms showing growth during follow-up were identified from our prospective aneurysm database. Three dimensional rotational angiography (3DRA) studies before and after morphology changes were available for all aneurysms included in the study, allowing for detailed shape and computational fluid dynamic (CFD) based hemodynamic analysis. Six patients fulfilled the inclusion criteria.

Results

Two different types of change were observed: focal growth, with bleb or blister formation in three, and global aneurysm enlargement accompanied by neck broadening in other three patients. Areas of focal growth showed low shear conditions with increased oscillations at the site of growth (a low wall shear stress [WSS] and high oscillatory shear index [OSI]). Global aneurysm enlargement was associated with increased WSS coupled with a high spatial wall shear stress gradient (WSSG).

Conclusion

For different aneurysm growth types, distinctive hemodynamic microenvironment may be responsible and temporal–spatial changes of the pathologic WSS would have the inciting effect. We suggest the distinction of focal and global growth types in future hemodynamic and histological studies.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2klo4RU

Diagnostic value of 99m Tc-ethambutol scintigraphy in tuberculosis: compared to microbiological and histopathological tests

Abstract

Objective

Tuberculosis (TB) still remains the world's endemic infection. TB affects the lungs and any part of the body other than the lung. The diagnosis of TB has not changed much over the decades. Ethambutol is one of the first line treatments for TB. It can be labeled using ^99mTc. ^99mTc-ethambutol will be accumulated in the site of TB lesion and can be imaged using gamma camera. The aim of this study was to evaluate the diagnostic value of ^99mTc-ethambutol scintigraphy in detecting and localizing of TB.

Methods

Retrospective cross-sectional study was done. Subjects were patients suspected of having TB infection. Whole body and SPECT-CT imaging at the suspected area was done 1 and 4 h after injection of 370–555 MBq ^99mTc-ethambutol. ^99mTc-ethambutol scintigraphy was analyzed visually. The results were compared with that of histopathological or microbiological tests. Statistical analysis was done to determine the sensitivity, specificity, PPV, NPV and accuracy.

Results

One hundred and sixty-eight subjects were involved in this study. There were 110 men and 58 women with mean age of 34.52 ± 11.94 years. There were concordance results in 156 (92.86%) and discordant in 12 (7.14%) subjects between ^99mTc-ethambutol scintigraphy and histopathological or microbiological result. The sensitivity, specificity, PPV, NPV and accuracy of ^99mTc-ethambutol scintigraphy in the diagnosis of pulmonary TB were 93.9, 85.7, 93.9, 85.7 and 91.4%, respectively, for extra-pulmonary TB 95.5, 77.8, 97.9, 63.6, and 85.1%, respectively, and for total tuberculosis 94.9, 83.3, 96.3, 78.1 and 92.8%, respectively. There was no side effect observed in this study.

Conclusion

^99mTc-ethambutol scintigraphy is a useful diagnostic imaging technique to detect and localize intra- and extra-pulmonary TB. It is safe to be performed even in pediatric patient. Consuming ethambutol less than 2 weeks did not influence the result.

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2iRzuMV

Correlation between mandibular bone density and skeletal bone density in a Catalonian postmenopausal population.

Correlation between mandibular bone density and skeletal bone density in a Catalonian postmenopausal population.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Nov 29;:

Authors: Estrugo-Devesa A, Segura-Egea J, García-Vicente L, Schemel-Suárez M, Blanco-Carrrión Á, Jané-Salas E, López-López J

Abstract
OBJECTIVES: The aim of this study was to determine if the mandible (MD) experiences reductions in bone mineral density (BMD) similar to the lumbar spine (LS) and femoral neck (FN) in a postmenopausal population.
STUDY DESIGN: A total of 137 postmenopausal women underwent 3 types of densitometric examinations: LS, FN, and MD as measured in 3 regions (MD-R1, MD-R2, and MD-R3), as well as the entire mandible (MD-Net) using a dual photon bone X-ray densitometer. Densitometry of the LS and FN were performed according to the protocol of the International Society for Clinical Densitometry. Mandibular densitometry was performed using a modification of a previous technique, placing the patient in the left lateral decubitus position, with the head supported by a 13-cm-thick cushion above the temporomandibular joint.
RESULTS: Significant correlations were found between densitometry results for the LS and the MD, with P values of .021 at MD-R1 (ramus); .001 at MD-R2 (body); .050 at MD-R3 (symphysis), and .001 at MD-Net (total mandibular density). No correlation was found between mandibular and FN densitometry (P > .05).
CONCLUSIONS: According to the results, for this population, it can be affirmed that the MD responds to osteoporosis in ways similar to the LS.

PMID: 29198430 [PubMed - as supplied by publisher]

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2AT8JP5

Determination of Thresholds of Radioactive Iodine Uptake Response With Clinical Exposure to Perchlorate: A Pooled Analysis.

Determination of Thresholds of Radioactive Iodine Uptake Response With Clinical Exposure to Perchlorate: A Pooled Analysis.

J Occup Environ Med. 2017 Dec 01;:

Authors: Bruce GM, Corey LM, Pearce EN, Braverman LE, Pleus RC

Abstract
OBJECTIVE: To conduct a more robust examination of perchlorate exposure on iodide uptake inhibition (IUI) using pooled data from four clinical studies of perchlorate exposure.
METHODS: To establish a response threshold for IUI, data were analyzed using segmented linear regression and benchmark dose (BMD) analysis.
RESULTS: Segmented linear regression applied to data for 69 subjects representing nine doses identified a breakpoint corresponding to a change in the slope of the dose-response relationship of 3.0 mg/d perchlorate. The estimated BMD for a 20% decrease in iodine uptake was 2.3 mg/d, with a lower 95% confidence interval limit of 1.6 mg/d.
CONCLUSIONS: A threshold dose for IUI from perchlorate exposure of 1.60 to 3.0 mg/d (0.021 to 0.038 mg/kg d) was estimated using two modeling approaches. These estimates are slightly higher than the lowest observed effect level of 0.02 mg/kg d from the Greer Study.

PMID: 29200191 [PubMed - as supplied by publisher]

from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2AXdNT7

health technology; +380 new citations

380 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

health technology

These pubmed results were generated on 2017/12/05

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2AwiFva
via IFTTT

Primary Aldosteronism and Obstructive Sleep Apnea: Is This A Bidirectional Relationship?

Primary Aldosteronism and Obstructive Sleep Apnea: Is This A Bidirectional Relationship?

Horm Metab Res. 2017 Dec;49(12):969-976

Authors: Prejbisz A, Kołodziejczyk-Kruk S, Lenders JWM, Januszewicz A

Abstract
It has been suggested that the high prevalence of obstructive sleep apnea (OSA) in resistant hypertension (RHT) may be related to the high prevalence of primary aldosteronism (PA) in patients with RHT. It has been also hypothesized that the relationship between aldosterone and OSA might be bidirectional. In patients with RHT, it has been shown that aldosterone levels correlate with severity of OSA and that blockade of aldosterone reduces the severity of OSA. It has been postulated that aldosterone worsens OSA by promoting accumulation of fluid, which shifted in the supine position to the neck, contributes to increased upper airway resistance. Also there is growing data that PA is more frequent in patients with OSA and that the treatment of PA positively influences OSA course. Also in some studies it has been shown that patients with OSA are characterized by higher aldosterone levels and higher prevalence of PA than patients without OSA and that causal treatment of OSA might decrease aldosterone levels. Moreover, the recent guideline of the Endocrine Society on management of PA recommends to screen hypertensive patients with OSA for PA.

PMID: 29202496 [PubMed - in process]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2AtIVsk
via IFTTT

Health-Related Quality of Life and Mental Health in Primary Aldosteronism: A Systematic Review.

Health-Related Quality of Life and Mental Health in Primary Aldosteronism: A Systematic Review.

Horm Metab Res. 2017 Dec;49(12):943-950

Authors: Velema MS, de Nooijer AH, Burgers VWG, Hermus ARMM, Timmers HJLM, Lenders JWM, Husson O, Deinum J

Abstract
The aim of this review was to determine the impact of primary aldosteronism on health-related quality of life (HRQoL) and mental health. We performed a systematic literature search up to July 2017 in six electronic databases. First, we screened the articles derived from this search based on title and abstract. Second, the selected studies were systematically reviewed and checked for our predefined inclusion criteria. The search yielded 753 articles, of which 15 studies met our inclusion criteria. Untreated patients with primary aldosteronism showed an impaired physical and mental HRQoL as compared to the general population. Multiple domains of HRQoL were affected. This applied to patients with both an aldosterone-producing adenoma and bilateral adrenal hyperplasia. Adrenalectomy improves HRQoL. Conflicting results have been reported on the extent of this improvement, the improvement after initiation of medical treatment, and whether there is a difference in HRQoL after both treatments. Similarly, psychopathological symptoms of anxiety, demoralization, stress, depression and nervousness were more frequently reported in untreated patients with primary aldosteronism than in the general population and patients with hypertension. Also an impaired sleep quality has been reported. Improvement of these symptoms was observed after treatment with both adrenalectomy and mineralocorticoid receptor antagonists. This review shows that HRQoL is impaired and psychopathology is more frequently reported in patients with primary aldosteronism. This seems to be at least partly reversible after treatment but the extent of improvement remains unknown. To assess HRQoL in these patients more precisely a primary aldosteronism-specific HRQoL questionnaire is required.

PMID: 29202493 [PubMed - in process]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2AvkWH9
via IFTTT

Nasospheroids permit measurements of CFTR-dependent fluid transport.

Nasospheroids permit measurements of CFTR-dependent fluid transport.

JCI Insight. 2017 Nov 16;2(22):

Authors: Guimbellot JS, Leach JM, Chaudhry IG, Quinney NL, Boyles SE, Chua M, Aban I, Jaspers I, Gentzsch M

Abstract
Expansion of novel therapeutics to all patients with cystic fibrosis (CF) requires personalized CFTR modulator therapy. We have developed nasospheroids, a primary cell culture-based model derived from individual CF patients and healthy subjects by a minimally invasive nasal biopsy. Confocal microscopy was utilized to measure CFTR activity by analyzing changes in cross-sectional area over time that resulted from CFTR-mediated ion and fluid movement. Both the rate of change over time and AUC were calculated. Non-CF nasospheroids with active CFTR-mediated ion and fluid movement showed a reduction in cross-sectional area, whereas no changes were observed in CF spheroids. Non-CF spheroids treated with CFTR inhibitor lost responsiveness for CFTR activation. However, nasospheroids from F508del CF homozygotes that were treated with lumacaftor and ivacaftor showed a significant reduction in cross-sectional area, indicating pharmacologic rescue of CFTR function. This model employs a simple measurement of size corresponding to changes in CFTR activity and is applicable for detection of small changes in CFTR activity from individual patients in vitro. Advancements of this technique will provide a robust model for individualized prediction of CFTR modulator efficacy.

PMID: 29202459 [PubMed - as supplied by publisher]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2AskZoU
via IFTTT

Risk Factors and Functional Impact of Medical Complications in Stroke.

Risk Factors and Functional Impact of Medical Complications in Stroke.

Ann Rehabil Med. 2017 Oct;41(5):753-760

Authors: Kim BR, Lee J, Sohn MK, Kim DY, Lee SG, Shin YI, Oh GJ, Lee YS, Joo MC, Han EY, Kim YH

Abstract
Objective: To determine the incidence and risk factors for medical complications in Korean patients suffering from stroke and the impact of such complications on post-stroke functional outcomes.
Methods: We assessed patients enrolled in a prospective cohort study. All recruited patients had suffered a first acute stroke episode and been admitted to nine university hospitals in Korea between August 2012 and June 2015. We analyzed patient and stroke characteristics, comorbidities, prevalence of post-stroke medical complications, and functional outcomes at time of discharge and 3, 6, and 12 months after stroke onset.
Results: Of 10,625 patients with acute stroke, 2,210 (20.8%) presented with medical complications including bladder dysfunction, bowel dysfunction, sleep disturbance, pneumonia, and urinary tract infection. In particular, complications occurred more frequently in older patients and in patients with hemorrhagic strokes, more co-morbidities, severe initial motor impairment, or poor swallowing function. In-hospital medical complications were significantly correlated with poor functional outcomes at all time points.
Conclusion: Post-stroke medical complications affect functional recovery. The majority of complications are preventable and treatable; therefore, the functional outcomes of patients with stroke can be improved by providing timely, appropriate care. Special care should be provided to elderly patients with comorbid risk factors.

PMID: 29201813 [PubMed]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2AxyRwe
via IFTTT

Reminders make people adhere better to a self-help sleep intervention.

Reminders make people adhere better to a self-help sleep intervention.

Health Technol (Berl). 2017;7(2):173-188

Authors: Horsch C, Spruit S, Lancee J, van Eijk R, Beun RJ, Neerincx M, Brinkman WP

Abstract
The experiment presented in this paper investigated the effects of different kinds of reminders on adherence to automated parts of a cognitive behavioural therapy for insomnia (CBT-I) delivered via a mobile device. Previous studies report that computerized health interventions can be effective. However, treatment adherence is still an issue. Reminders are a simple technique that could improve adherence. A minimal intervention prototype in the realm of sleep treatment was developed to test the effects of reminders on adherence. Two prominent ways to determine the reminder-time are: a) ask users when they want to be reminded, and b) let an algorithm decide when to remind users. The prototype consisted of a sleep diary, a relaxation exercise and reminders. A within subject design was used in which the effect of reminders and two underlying principles were tested by 45 participants that all received the following three different conditions (in random order): a) event-based reminders b) time-based reminders c) no reminders. Both types of reminders improved adherence compared to no reminders. No differences were found between the two types of reminders. Opportunity and self-empowerment could partly mediate adherence to filling out the sleep diary, but not to the number of relaxation exercises conducted. Although the study focussed on CBT-I, we expect that designers of other computerized health interventions benefit from the tested opportunity and self-empowerment principles for reminders to improve adherence, as well.

PMID: 29201588 [PubMed]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2At3mWb
via IFTTT

Recent developments in genetics and medically assisted reproduction: from research to clinical applications.

Recent developments in genetics and medically assisted reproduction: from research to clinical applications.

Eur J Hum Genet. 2017 Dec 04;:

Authors: Harper JC, Aittomäki K, Borry P, Cornel MC, de Wert G, Dondorp W, Geraedts J, Gianaroli L, Ketterson K, Liebaers I, Lundin K, Mertes H, Morris M, Pennings G, Sermon K, Spits C, Soini S, van Montfoort APA, Veiga A, Vermeesch JR, Viville S, Macek M, on behalf of the European Society of Human Reproduction and Embryology and European Society of Human Genetics

Abstract
Two leading European professional societies, the European Society of Human Genetics and the European Society for Human Reproduction and Embryology, have worked together since 2004 to evaluate the impact of fast research advances at the interface of assisted reproduction and genetics, including their application into clinical practice. In September 2016, the expert panel met for the third time. The topics discussed highlighted important issues covering the impacts of expanded carrier screening, direct-to-consumer genetic testing, voiding of the presumed anonymity of gamete donors by advanced genetic testing, advances in the research of genetic causes underlying male and female infertility, utilisation of massively parallel sequencing in preimplantation genetic testing and non-invasive prenatal screening, mitochondrial replacement in human oocytes, and additionally, issues related to cross-generational epigenetic inheritance following IVF and germline genome editing. The resulting paper represents a consensus of both professional societies involved.

PMID: 29199274 [PubMed - as supplied by publisher]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2iU6Afa
via IFTTT

Effects of Patent Foramen Ovale Closure on Obstructive Sleep Apnea Syndrome: PCOSA Study.

Related Articles

Effects of Patent Foramen Ovale Closure on Obstructive Sleep Apnea Syndrome: PCOSA Study.

Can J Cardiol. 2017 Dec;33(12):1708-1715

Authors: Hoole SP, Hernández-Sánchez J, Davies WR, McNab DC, Calvert PA, Rana BS, Shapiro LM, Davies MG

Abstract
BACKGROUND: Previous studies have shown a higher prevalence of patent foramen ovale (PFO) in patients with obstructive sleep apnea syndrome (OSAS). Right to left shunting through a PFO may be encouraged by the respiratory physiology of OSAS, contributing to the disease pathophysiology. We assessed whether PFO closure would improve respiratory polygraphy parameters compared with baseline measurements in patients with OSAS.
METHODS: Twenty-six patients with newly diagnosed OSAS and a moderate-large PFO (prevalence, 18% of 143 patients screened) were referred for PFO closure. The oxygen desaturation index (ODI), apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), 6-minute walk test (6MWT), and Sleep Apnea Quality of Life Index (SAQLI) results were compared in these patients at baseline (before continuous positive pressure ventilation [CPAP]) and at 6-month follow-up (after interrupting CPAP for 1 week).
RESULTS: All PFOs were safely sealed at 6 months, as confirmed by repeated transthoracic echocardiography. The ODI (44.8 [interquartile range (IQR), 31.2-63.5) vs 42.3 [IQR, 34.0-60.8]; P = 0.89) and AHI (47.9 [IQR, 31.5-65.2] vs 42.3 [IQR, 32.1-63]; P = 0.99) did not change after PFO closure nor did the 6MWT, although the ESS (13.0 [IQR, 12.0-16.8] vs 6.0 [IQR, 4.0-8.8]; P < 0.001) and the SAQLI (3.4 [IQR, 2.8-4.3] vs 4.4 [IQR, 3.9-5.3]; P < 0.001) did improve.
CONCLUSIONS: The prevalence of PFO in OSAS appears to be no higher than that in the general population. Although PFO closure is safe and effective, it did not improve respiratory polygraphy measures of OSAS severity. The improvement in the ESS and SAQLI likely reflect residual benefits from CPAP.

PMID: 29173609 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2ATEzv8
via IFTTT

The Economics of Prepectoral Breast Reconstruction.

Related Articles

The Economics of Prepectoral Breast Reconstruction.

Plast Reconstr Surg. 2017 Dec;140(6S Prepectoral Breast Reconstruction):49S-52S

Authors: Glasberg SB

Abstract
The world of breast reconstruction over the last several years has seen a dramatic shift in focus to discussion and the application of placing tissue expanders and implants back into the prepectoral space. Although this technique failed during the early advent of breast reconstruction, newer technologies such as advances in fat grafting, improved acellular dermal matrices, better methods of assessing breast flap viability, and enhanced implants appear to have set the stage for the resurgence and positive early results seen with this technique. The main benefits of a switch to prepectoral breast reconstruction clinically appears to be less associated pain, lower incidence of animation deformities, and its associated symptoms as well as presumably better aesthetics. Early data suggest that the results are extremely promising and early adopters have attempted to define the ideal patients for prepectoral breast reconstruction. As with any new operative procedure, an assessment of finances and costs are crucial to its successful implementation. Although current data are minimal, this article attempts to build the fundamentals of an economic model that exhibits and displays potential savings through the use of prepectoral breast reconstruction.

PMID: 29166348 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2hOv59p
via IFTTT

Interleukin-1 Blockade in Recently Decompensated Systolic Heart Failure: Results From REDHART (Recently Decompensated Heart Failure Anakinra Response Trial).

Related Articles

Interleukin-1 Blockade in Recently Decompensated Systolic Heart Failure: Results From REDHART (Recently Decompensated Heart Failure Anakinra Response Trial).

Circ Heart Fail. 2017 Nov;10(11):

Authors: Van Tassell BW, Canada J, Carbone S, Trankle C, Buckley L, Oddi Erdle C, Abouzaki NA, Dixon D, Kadariya D, Christopher S, Schatz A, Regan J, Viscusi M, Del Buono M, Melchior R, Mankad P, Lu J, Sculthorpe R, Biondi-Zoccai G, Lesnefsky E, Arena R, Abbate A

Abstract
BACKGROUND: An enhanced inflammatory response predicts worse outcomes in heart failure (HF). We hypothesized that administration of IL-1 (interleukin-1) receptor antagonist (anakinra) could inhibit the inflammatory response and improve peak aerobic exercise capacity in patients with recently decompensated systolic HF.
METHODS AND RESULTS: We randomly assigned 60 patients with reduced left ventricular ejection fraction (<50%) and elevated C-reactive protein levels (>2 mg/L), within 14 days of hospital discharge, to daily subcutaneous injections with anakinra 100 mg for 2 weeks, 12 weeks, or placebo. Patients underwent measurement of peak oxygen consumption (Vo2 [mL/kg per minute]) and ventilatory efficiency (the VE/Vco2 slope). Treatment with anakinra did not affect peak Vo2 or VE/Vco2 slope at 2 weeks. At 12 weeks, patients continued on anakinra showed an improvement in peak Vo2 from 14.5 (10.5-16.6) mL/kg per minute to 16.1 (13.2-18.6) mL/kg per minute (P=0.009 for within-group changes), whereas no significant changes occurred within the anakinra 2-week or placebo groups. The between-groups differences, however, were not statistically significant. The incidence of death or rehospitalization for HF at 24 weeks was 6%, 31%, and 30%, in the anakinra 12-week, anakinra 2-week, and placebo groups, respectively (log-rank test P=0.10).
CONCLUSIONS: No change in peak Vo2 occurred at 2 weeks in patients with recently decompensated systolic HF treated with anakinra, whereas an improvement was seen in those patients in whom anakinra was continued for 12 weeks. Additional larger studies are needed to validate the effects of prolonged anakinra on peak Vo2 and rehospitalization for HF.
CLINICAL TRIAL REGISTRATION: URL: http://ift.tt/PmpYKN. Unique identifier: NCT01936909.

PMID: 29141858 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2ARkmpE
via IFTTT

Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy.

Related Articles

Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy.

Circ Heart Fail. 2017 Nov;10(11):

Authors: Shen L, Ramires F, Martinez F, Bodanese LC, Echeverría LE, Gómez EA, Abraham WT, Dickstein K, Køber L, Packer M, Rouleau JL, Solomon SD, Swedberg K, Zile MR, Jhund PS, Gimpelewicz CR, McMurray JJV, PARADIGM-HF and ATMOSPHERE Investigators and Committees

Abstract
BACKGROUND: Chagas' disease is an important cause of cardiomyopathy in Latin America. We aimed to compare clinical characteristics and outcomes in patients with heart failure (HF) with reduced ejection fraction caused by Chagas' disease, with other etiologies, in the era of modern HF therapies.
METHODS AND RESULTS: This study included 2552 Latin American patients randomized in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients With Heart Failure) trials. The investigator-reported etiology was categorized as Chagasic, other nonischemic, or ischemic cardiomyopathy. The outcomes of interest included the composite of cardiovascular death or HF hospitalization and its components and death from any cause. Unadjusted and adjusted Cox proportional hazards models were performed to compare outcomes by pathogenesis. There were 195 patients with Chagasic HF with reduced ejection fraction, 1300 with other nonischemic cardiomyopathy, and 1057 with ischemic cardiomyopathy. Compared with other etiologies, Chagasic patients were more often female, younger, and had lower prevalence of hypertension, diabetes mellitus, and renal impairment (but had higher prevalence of stroke and pacemaker implantation) and had worse health-related quality of life. The rates of the composite outcome were 17.2, 12.5, and 11.4 per 100 person-years for Chagasic, other nonischemic, and ischemic patients, respectively-adjusted hazard ratio for Chagasic versus other nonischemic: 1.49 (95% confidence interval, 1.15-1.94; P=0.003) and Chagasic versus ischemic: 1.55 (1.18-2.04; P=0.002). The rates of all-cause mortality were also higher.
CONCLUSIONS: Despite younger age, less comorbidity, and comprehensive use of conventional HF therapies, patients with Chagasic HF with reduced ejection fraction continue to have worse quality of life and higher hospitalization and mortality rates compared with other etiologies.
CLINICAL TRIAL REGISTRATION: PARADIGM-HF: URL: http://ift.tt/PmpYKN. Unique identifier: NCT01035255; ATMOSPHERE: URL: http://ift.tt/PmpYKN. Unique identifier: NCT00853658.

PMID: 29141857 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2iqfFZo
via IFTTT

Holistic care of complicated tuberculosis in healthcare settings with limited resources.

Related Articles

Holistic care of complicated tuberculosis in healthcare settings with limited resources.

Arch Dis Child. 2017 Dec;102(12):1161-1168

Authors: Duke T, Kasa Tom S, Poka H, Welch H

Abstract
In recent years, most of the focus on improving the quality of paediatric care in low-income countries has been on improving primary care using the Integrated Management of Childhood Illness, and improving triage and emergency treatment in hospitals aimed at reducing deaths in the first 24 hours. There has been little attention paid to improving the quality of care for children with chronic or complex diseases. Children with complicated forms of tuberculosis (TB), including central nervous system and chronic pulmonary TB, provide examples of acute and chronic multisystem paediatric illnesses that commonly present to district-level and second-level referral hospitals in low-income countries. The care of these children requires a holistic clinical and continuous quality improvement approach. This includes timely decisions on the commencement of treatment often when diagnoses are not certain, identification and management of acute respiratory, neurological and nutritional complications, identification and treatment of comorbidities, supportive care, systematic monitoring of treatment and progress, rehabilitation, psychological support, ensuring adherence, and safe transition to community care. New diagnostics and imaging can assist this, but meticulous attention to clinical detail at the bedside and having a clear plan for all aspects of care that is communicated well to staff and families are essential for good outcomes. The care is multidimensional: biomedical, rehabilitative, social and economic, and multidisciplinary: medical, nursing and allied health. In the era of the Sustainable Development Goals, approaches to these dimensions of healthcare are needed within the reach of the poorest people who access district hospitals in low-income countries.

PMID: 28912165 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2xpntDb
via IFTTT

Superthin SCIP Flap for Reconstruction of Subungual Melanoma: Aesthetic Functional Surgery.

Related Articles

Superthin SCIP Flap for Reconstruction of Subungual Melanoma: Aesthetic Functional Surgery.

Plast Reconstr Surg. 2017 Dec;140(6):1278-1289

Authors: Lee KT, Park BY, Kim EJ, Kim JH, Jang KT, Choi SH, Lee DY, Mun GH

Abstract
BACKGROUND: This study aimed to use a superthin, free superficial circumflex iliac artery perforator (SCIP) flap in functional surgery for treating subungual melanoma and to evaluate its outcomes.
METHODS: Forty-one patients with primary subungual melanoma of less than or equal to 2-mm thickness who were treated with functional surgery were prospectively enrolled. After oncologic resection, a thin SCIP flap was harvested along the trans-superficial fat layer and transferred to the defect with further thinning by primary defatting. Complications and oncologic outcomes were investigated. Postoperative functional status was assessed, using the Quick Disabilities of the Arm, Shoulder and Hand questionnaire for finger cases and the Foot Function Index for toe cases, and was compared with that of patients treated with amputation.
RESULTS: The SCIP flap was inset with a final thickness ranging from 1.5 to 4 mm after defatting. Total flap failure occurred in one patient. Complete wound healing was achieved within 3 weeks postoperatively in most cases (90.2 percent). The majority of patients achieved satisfactory contour without needing secondary debulking. Two recurrences developed during a mean follow-up period of 31 months: one local recurrence and one in-transit recurrence. The 3-year disease-free survival was 97.1 percent. Mean scores for the Quick Disabilities of the Arm, Shoulder and Hand questionnaire and the Foot Function Index following functional surgery were significantly lower than those following amputation.
CONCLUSION: The superthin SCIP flap might serve as a valuable reconstruction option, providing aesthetically thin coverage and reliable outcomes, in functional surgery for treating early-stage subungual melanoma.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

PMID: 28820834 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2wZH22n
via IFTTT

Assessment of work-related accidents associated with waste handling in Belo Horizonte (Brazil).

Related Articles

Assessment of work-related accidents associated with waste handling in Belo Horizonte (Brazil).

Waste Manag Res. 2017 Oct;35(10):1084-1092

Authors: Mol MP, Pereira AF, Greco DB, Cairncross S, Heller L

Abstract
As more urban solid waste is generated, managing it becomes ever more challenging and the potential impacts on the environment and human health also become greater. Handling waste - including collection, treatment and final disposal - entails risks of work accidents. This article assesses the perception of waste management workers regarding work-related accidents in domestic and health service contexts in Belo Horizonte, Brazil. These perceptions are compared with national data from the Ministry of Social Security on accidents involving workers in solid waste management. A high proportion of accidents involves cuts and puncture injuries; 53.9% among workers exposed to domestic waste and 75% among those exposed to health service waste. Muscular lesions and fractures accounted for 25.7% and 12.5% of accidents, respectively. Data from the Ministry of Social Security diverge from the local survey results, presumably owing to under-reporting, which is frequent in this sector. Greater commitment is needed from managers and supervisory entities to ensure that effective measures are taken to protect workers' health and quality of life. Moreover, workers should defend their right to demand an accurate registry of accidents to complement monitoring performed by health professionals trained in risk identification. This would contribute to the improved recovery of injured workers and would require managers in waste management to prepare effective preventive action.

PMID: 28816103 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2iVQD81
via IFTTT

Effects of air pollution and seasons on health-related quality of life of Mongolian adults living in Ulaanbaatar: cross-sectional studies.

Related Articles

Effects of air pollution and seasons on health-related quality of life of Mongolian adults living in Ulaanbaatar: cross-sectional studies.

BMC Public Health. 2017 Jun 23;17(1):594

Authors: Nakao M, Yamauchi K, Ishihara Y, Omori H, Ichinnorov D, Solongo B

Abstract
BACKGROUND: Ulaanbaatar, Mongolia, is known as severely air-polluted city in the world due to increased coal consumption in the cold season. The health effects of air pollution in Mongolia such as mortality, morbidity and symptoms have been previously reported. However, the concept of health-related quality of life (HR-QoL), which refers to the individual's perception of well-being, should also be included as an adverse health outcome of air pollution.
METHODS: Surveys on the Mongolian people living in Ulaanbaatar were performed in the warm and cold seasons. Self-completed questionnaires on the subjects' HR-QoL, data from health checkups and pulmonary function tests by respiratory specialists were collected for Mongolian adults aged 40-79 years (n = 666). Ambient PM2.5 and PM10 were concurrently sampled and the components were analyzed to estimate the source of air pollution.
RESULTS: In logistic regression analyses, respiratory symptoms and smoke-rich fuels were associated with reduced HR-QoL (> 50th percentile vs. ≤ 50th percentile). PM 2.5 levels were much higher in the cold season (median 86.4 μg/m3 (IQR: 58.7-121.0)) than in the warm season (12.2 μg/m3 (8.9-21.2). The receptor model revealed that the high PM2.5 concentration in the cold season could be attributed to solid fuel combustion. The difference in HR-QoL between subjects with and without ventilatory impairment was assessed after the stratification of the subjects by season and household fuel type. There were no significant differences in HR-QoL between subjects with and without ventilatory impairment regardless of household fuel type in the warm season. In contrast, subjects with ventilatory impairment who used smoke-rich fuel in the cold season had a significantly lower HR-QoL.
CONCLUSIONS: Our study showed that air pollution in Ulaanbaatar worsened in the cold season and was estimated to be contributed by solid fuel combustion. Various aspects of HR-QoL in subjects with ventilatory impairment using smoke-rich fuels deteriorated only in the cold season while those with normal lung function did not. These results suggest that countermeasures or interventions by the policymakers to reduce coal usage would improve HR-QoL of the residents of Ulaanbaatar, especially for those with ventilatory impairment in the winter months.

PMID: 28645332 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2ASMby4
via IFTTT

Frequency of somatic symptoms in the general population: Normative values for the Patient Health Questionnaire-15 (PHQ-15).

Related Articles

Frequency of somatic symptoms in the general population: Normative values for the Patient Health Questionnaire-15 (PHQ-15).

J Psychosom Res. 2017 May;96:27-31

Authors: Hinz A, Ernst J, Glaesmer H, Brähler E, Rauscher FG, Petrowski K, Kocalevent RD

Abstract
BACKGROUND: The PHQ-15 is widely used as an open access screening instrument for somatic symptoms in different health care settings. The objectives of the study were to contribute to the construct validity and to generate normative data for the PHQ-15.
METHODS: The survey was conducted in the general population in Germany from August 2011 to November 2014 (n=9250). All participants underwent an extensive core assessment including a set of questionnaires.
RESULTS: Men reported significantly less (p<0.001) physical symptoms than women (4.6 [SD=3.6] vs. 6.3 [SD=4.1]). The PHQ-15 total score was strongly correlated with the physical component of quality of life (r=-0.58), fatigue (r=0.56), anxiety (r=0.54) and sleep problems (r=0.54). While high socioeconomic status was associated with low prevalences of all complaints, obesity was associated with some of the complaints, especially shortness of breath and pain in arms, legs, and joints. Normative data for the PHQ-15 were generated for men and women.
CONCLUSIONS: This investigation confirms the burden caused by somatic symptoms in terms of impaired physical quality of life. In association with psychosocial consequences such as anxiety as well as sleep problems, future studies should also focus on the disease burden of somatic symptoms. In addition, the normative data provide a framework for the interpretation and comparison with other populations.

PMID: 28545789 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2qYJBAG
via IFTTT

The associations between insomnia and health-related quality of life in rehabilitation units at 1month after stroke.

Related Articles

The associations between insomnia and health-related quality of life in rehabilitation units at 1month after stroke.

J Psychosom Res. 2017 May;96:10-14

Authors: Kim WH, Jung HY, Choi HY, Park CH, Kim ES, Lee SJ, Ko SH, Kim SY, Joa KL

Abstract
OBJECTIVE: The principal objective of this study was to investigate the relationship between insomnia and health-related quality of life (HRQoL) during the early stage of stroke rehabilitation.
METHODS: The subjects were 214 first-time stroke patients admitted to a rehabilitation unit at one of three Korean hospitals. Within 7days after stroke, functions were evaluated using; the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, the Frontal Assessment Battery, Screening Tests for Aphasia and Neurologic-Communication Disorders, and the National Institute of Health Stroke Scale. Insomnia, depression, anxiety, and HRQoL were investigated at one month after stroke. Insomnia was defined as presence of at least one of the four following; difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and non-restorative sleep. HRQoL was assessed using the Short Form Health survey SF-8. Depression and anxiety were measured using the Hospital Anxiety Depression Scale. Multivariate linear regression analysis was conducted to examine the association between insomnia and HRQoL.
RESULTS: The prevalence of insomnia at one month after stroke was 59.5%. Patients with insomnia were more likely to be older and female and to have depression and anxiety. Patients with insomnia had poorer physical and mental HRQoL. By multivariate analyses, physical HRQoL was significantly associated with type of stroke, hypnotic usage, balancing function, and insomnia. Mental HRQoL was significantly associated with balancing function, depression, and insomnia.
CONCLUSION: Insomnia was found to be negatively associated with physical and mental HRQoL in stroke patients during the early stage of rehabilitation.

PMID: 28545786 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2ARyq2p
via IFTTT

Life Impact and Treatment Preferences of Individuals with Asthma and Chronic Obstructive Pulmonary Disease: Results from Qualitative Interviews and Focus Groups.

Related Articles

Life Impact and Treatment Preferences of Individuals with Asthma and Chronic Obstructive Pulmonary Disease: Results from Qualitative Interviews and Focus Groups.

Adv Ther. 2017 Jun;34(6):1466-1481

Authors: Svedsater H, Roberts J, Patel C, Macey J, Hilton E, Bradshaw L

Abstract
INTRODUCTION: The impact of asthma and chronic obstructive pulmonary disease (COPD) on individuals' lives may be substantial, yet clinical practice often focuses only on symptoms. We aimed to better understand the perspective of asthma or COPD patients and to identify condition-related burden, life impact, priorities, unmet needs, and treatment goals.
METHODS: Individuals aged at least 18 years with asthma or COPD were identified by a recruitment panel via clinical referrals, support groups, consumer networks, and a patient database. Interviews were carried out individually (by telephone) or in focus groups (with no more than five participants per group). A semi-structured interview guide was used with prespecified topics, informed by a literature review, that were considered impactful in asthma or COPD (symptoms and daily-life impact, satisfaction with current treatment, important aspects of treatment, adherence, and ideal treatment).
RESULTS: Overall, 72 people participated in focus groups/individual interviews (asthma n = 18/n = 21; COPD n = 15/n = 18). "Shortness of breath" was the most frequently reported symptom; however, participants discussed the life impact of their condition more than symptoms alone. Reported physical impacts included the inability to sleep and socialize, while emotional impacts included "embarrassment, stigma, and/or self-consciousness", "fear and/or panic", and "sadness, anxiety, and/or depression". Coping mechanisms for normal activities included continuing at reduced pace and avoidance. Treatment preferences centered on resolving impacts; improved sleep, "speed of action", and "length of relief" were the most frequently reported ideal treatment factors.
CONCLUSION: Patients with asthma or COPD experience substantial quality of life limitations and tend to focus on these in their expressions of concern, rather than symptoms per se. Life impacts of these conditions may have implications beyond those commonly appreciated in routine practice; these considerations will be applied to a future discrete choice experiment survey.
FUNDING: GSK funded study (H0-15-15502/204821).

PMID: 28536998 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2iUmiqz
via IFTTT

Perceptions of Painful Diabetic Peripheral Neuropathy in South-East Asia: Results from Patient and Physician Surveys.

Related Articles

Perceptions of Painful Diabetic Peripheral Neuropathy in South-East Asia: Results from Patient and Physician Surveys.

Adv Ther. 2017 Jun;34(6):1426-1437

Authors: Malik RA, Aldinc E, Chan SP, Deerochanawong C, Hwu CM, Rosales RL, Yeung CY, Fujii K, Parsons B

Abstract
There are no data on physician-patient communication in painful diabetic peripheral neuropathy (pDPN) in the Asia-Pacific region. The objective of this study was to examine patient and physician perceptions of pDPN and clinical practice behaviors in five countries in South-East Asia. Primary care physicians and practitioners, endocrinologists, diabetologists, and patients with pDPN completed separate surveys on pDPN diagnosis, impact, management, and physician-patient interactions in Hong Kong, Malaysia, the Philippines, Taiwan, and Thailand. Data were obtained from 100 physicians and 100 patients in each country. The majority of physicians (range across countries, 30-85%) were primary care physicians and practitioners. Patients were mostly aged 18-55 years and had been diagnosed with diabetes for >5 years. Physicians believed pDPN had a greater impact on quality of life than did patients (ranges 83-92% and 39-72%, respectively), but patients believed pDPN had a greater impact on items such as sleep, anxiety, depression, and work than physicians. Physicians considered the diagnosis and treatment of pDPN a low priority, which may be reflected in the generally low incidence of screening (range 12-65%) and a lack of awareness of pDPN. Barriers to treatment included patients' lack of awareness of pDPN. Both physicians and patients agreed that pain scales and local language descriptions were the most useful tools in helping to describe patients' pain. Most patients were monitored upon diagnosis of pDPN (range 55-97%), but patients reported a shorter duration of monitoring compared with physicians. Both physicians and patients agreed that it was patients who initiated conversations on pDPN. Physicians most commonly referred to guidelines from the American Diabetes Association or local guidelines for the management of pDPN. This study highlights important differences between physician and patient perceptions of pDPN, which may impact on its diagnosis and treatment. For a chronic and debilitating complication like pDPN, the physician-patient dialogue is central to maximizing patient outcomes. Strategies, including education of both groups, need to be developed to improve communication.
FUNDING: Pfizer.

PMID: 28502036 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2iUcTzp
via IFTTT

Provision of Palliative Care Services by Family Physicians Is Common.

Related Articles

Provision of Palliative Care Services by Family Physicians Is Common.

J Am Board Fam Med. 2017 Mar-Apr;30(2):255-257

Authors: Ankuda CK, Jetty A, Bazemore A, Petterson S

Abstract
OBJECTIVE: Provision of palliative care services by primary care physicians is increasingly important with an aging population, but it is unknown whether US primary care physicians see themselves as palliative practitioners.
METHODS: This study used cross-sectional analysis of data from the 2013 American Board of Family Medicine Maintenance of Certification Demographic Survey.
RESULTS: Of 10,894 family physicians, 33.1% (n = 3609) report providing palliative care. Those providing palliative care are significantly more likely to provide non-clinic-based services such as care in nursing homes, home visits, and hospice. Controlling for other characteristics, physicians reporting palliative care provision are significantly (P < .05) more likely to be older, white, male, rural, and practicing in a patient-centered medical home.
CONCLUSION: One third of family physicians recertifying in 2013 reported providing palliative care, with physician and practice characteristics driving reporting palliative care provision.

PMID: 28379833 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2iTdzF2
via IFTTT

Association between Continuity of Care and Health-Related Quality of Life.

Related Articles

Association between Continuity of Care and Health-Related Quality of Life.

J Am Board Fam Med. 2017 Mar-Apr;30(2):205-212

Authors: Bayliss EA, Ellis JL, Shoup JA, McQuillan DB, Steiner JF, Zeng C

Abstract
BACKGROUND: Patient-reported outcomes (PROs) are considered potential quality metrics for patients with multiple chronic medical conditions (MCC). Although continuity of care (COC) is an essential MCC care process, the association between common PROs and COC is unknown.
METHODS: We assessed baseline and two-year follow-up self-reported health status, physical, and emotional well-being, and COC in seniors with MCC. Using mixed effects models with repeated measures adjusting for age, gender, and morbidity, we assessed each outcome as a function of COC.
RESULTS: Of 2,078 seniors, 961 completed the initial survey and 806 completed follow-up. On a 0-100 scale, mean (sd) baseline self-reported health status, physical well-being, and emotional well-being were 48.7 (22.0), 36.4 (11.4), and 54.8 (9.0). On a 0 to 1 scale, mean baseline and 2-year COC were 0.24 (sd 0.22) and 0.22 (0.18). Follow-up self-reported health status, physical well-being, and emotional well-being were 48.8 (23.1), 36.5 (11.5), and 55.3 (8.8). In adjusted primary and secondary analyses using all available data, there were no associations between any outcomes and COC.
CONCLUSION: Given the measurement burden of quality assessment, negative associations between potential quality metrics and care processes are informative. Systematic assessment of PROs can inform patient-centered MCC care. However, PRO scores should be used with caution as quality measures.

PMID: 28379827 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2ATqltY
via IFTTT

Prediction of Suicide Ideation and Attempt Among Substance-Using Patients in Primary Care.

Related Articles

Prediction of Suicide Ideation and Attempt Among Substance-Using Patients in Primary Care.

J Am Board Fam Med. 2017 Mar-Apr;30(2):150-160

Authors: Hallgren KA, Ries RK, Atkins DC, Bumgardner K, Roy-Byrne P

Abstract
BACKGROUND: Suicide is a major public health concern, particularly among people who use illicit substances and/or non-prescribed medications.
METHODS: The present study prospectively assessed the incidence and predictors of suicidal ideation (SI) and suicide attempt (SA) among 868 substance-using patients over 12 months after receiving primary care within seven public primary care clinics.
RESULTS: Participants reported a high incidence of SI (25.9%) and SA (7.1%) over the year following primary care visits. Suicidality was elevated in patients who were female; lacked a high school diploma; were unemployed; reported depression, anxiety, hallucinations, concentration difficulty, or violent behavior; used nicotine or stimulants; used the emergency department or mental health services in the past 90 days; reported current quality-of-life impairment in mobility or usual activities; or reported recent SI or lifetime SA at baseline. In multiple regression analyses, only past 30-day SI, any lifetime SA, past 90-day violent behavior, and current impairment due to anxiety or depression at baseline uniquely predicted SI or SA beyond other variables.
CONCLUSIONS: Results support the need for screening for suicidality among primary care patients who use illicit substances and identify key of these patients who are at particularly elevated risk for suicidality.

PMID: 28379821 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2nhMfkZ
via IFTTT

Rationale and design of ASTEROID 2, a randomized, placebo- and active comparator-controlled study to assess the efficacy and safety of vilaprisan in patients with uterine fibroids.

Related Articles

Rationale and design of ASTEROID 2, a randomized, placebo- and active comparator-controlled study to assess the efficacy and safety of vilaprisan in patients with uterine fibroids.

Contemp Clin Trials. 2017 Apr;55:56-62

Authors: Seitz C, Bumbuliene Ž, Costa AR, Heikinheimo O, Heweker A, Hudeček R, Jacquemyn Y, Melis GB, Parashar P, Rechberger T, Sánchez AC, van Aken B, Zatik J, Gemzell-Danielsson K

Abstract
BACKGROUND: Uterine fibroids (UFs) may be treated with progesterone receptor modulators (PRMs), which have been shown to reduce heavy menstrual bleeding and the size of UFs. To date, one PRM (ulipristal acetate) has received regulatory approval for the treatment of UFs; therapy comprises intermittent treatment courses of up to 3months each, followed by a break to allow two menstruations to occur. We report the design of ASTEROID (Assess Safety and efficacy of vilaprisan in patients with uTERine fibrOIDs) 2, a phase 2 study examining the efficacy and safety of a novel PRM, vilaprisan, in women with UFs.
METHODS/DESIGN: In this randomized multi-arm study, vilaprisan (2mg daily) will be administered in different regimens: continuous treatment for 12 or 24weeks, or two 12-week treatment periods separated by a break to allow one menstruation to occur. Efficacy and safety will be compared with that of ulipristal acetate (5mg daily) and placebo. Patients randomized to receive placebo for 12weeks will also be given active treatment for 12weeks. The primary measure of efficacy will be amenorrhoea rate; secondary measures include time to normalized menstrual bleeding and percentage change in UF volume. Endometrial changes will be monitored throughout the study.
DISCUSSION: The placebo- and active comparator-controlled trial ASTEROID 2 is the first study to evaluate systematically the efficacy and safety of different treatment regimens of PRMs in women with UFs. The findings of this study will direct the planning of future clinical trials of vilaprisan.

PMID: 28185997 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2iTdlOc
via IFTTT

MOTIVATional intErviewing to improve self-care in Heart Failure patients (MOTIVATE-HF): Study protocol of a three-arm multicenter randomized controlled trial.

Related Articles

MOTIVATional intErviewing to improve self-care in Heart Failure patients (MOTIVATE-HF): Study protocol of a three-arm multicenter randomized controlled trial.

Contemp Clin Trials. 2017 Apr;55:34-38

Authors: Vellone E, Paturzo M, D'Agostino F, Petruzzo A, Masci S, Ausili D, Rebora P, Alvaro R, Riegel B

Abstract
AIMS: Heart Failure (HF) self-care improves patient outcomes but trials designed to improve HF self-care have shown inconsistent results. Interventions may be more effective in improving self-care if they mobilize support from providers, promote self-efficacy, increase understanding of HF, increase the family involvement, and are individualized. All of these elements are emphasized in motivational interviewing (MI); few trials have been conducted using MI in HF patients and rarely have caregivers been involved in MI interventions. The aim of this study will be to evaluate if MI improves self-care maintenance in HF patients, and to determine if MI improves the following secondary outcomes: a) in HF patients: self-care management, self-care confidence, symptom perception, quality of life, anxiety/depression, cognition, sleep quality, mutuality with caregiver, hospitalizations, use of emergency services, and mortality; b) in caregivers: caregiver contribution to self-care, quality of life, anxiety/depression, sleep, mutuality with patient, preparedness, and social support.
METHODS: A three-arm randomized controlled trial will be conducted in a sample of 240 HF patients and caregivers. Patients and caregivers will be randomized to the following arms: 1) MI intervention to patients only; 2) MI intervention to patients and caregivers; 3) standard of care to patients and caregivers. The primary outcome will be measured in patients 3months after enrollment. Primary and secondary outcomes also will be evaluated 6, 9 and 12months after enrollment.
CONCLUSION: This study will contribute to understand if MI provided to patients and caregivers can improve self-care. Because HF is rising in prevalence, findings can be useful to reduce the burden of the disease.

PMID: 28185994 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2AU2H0s
via IFTTT

Points forts du 1er congrès de la Société francophone de néphrologie, dialyse et transplantation (SFNDT) – Strasbourg – du 4 au 7 octobre 2016.

Points forts du 1er congrès de la Société francophone de néphrologie, dialyse et transplantation (SFNDT) – Strasbourg – du 4 au 7 octobre 2016.

Nephrol Ther. 2016 Dec;12(7S):S1-S9

Authors: Fartoux L

PMID: 28132668 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2iUPihF
via IFTTT

The ethics of reporting all the results of clinical trials.

Related Articles

The ethics of reporting all the results of clinical trials.

Br Med Bull. 2017 Jan 01;121(1):19-29

Authors: Brassington I

Abstract
Introduction or background: The terms 'publication bias' and 'reporting bias' describe aspects of a phenomenon by which data from trials are not publicized, and so remain inaccessible. This may generate a false impression about the world; but those facts may have important implications for clinical decisions. Thus, the bias may leave patients worse off than they might be.
Sources of data: Published journal articles.
Areas of agreement: There is general agreement that the phenomenon happens, and that to the extent that it happens, it is undesirable for moral rather than simply epistemic reasons.
Growing points: There is a growing demand across the board for data to be better publicized.
Areas timely for developing research: There is room for further work on how protocols requiring that data be publicized might be enforced; should it be statutory, or non-statutory? Who should decide what should be made public? There is also room for work on what it is necessary to share, and on whether and how IP law should be reformed.

PMID: 28104631 [PubMed - indexed for MEDLINE]

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2iUPfT1
via IFTTT