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1.
Ann Surg ; 277(4): e766-e771, 2023 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35129504

RESUMO

OBJECTIVE: To assess whether different methods for communicating the probability of treatment complications for operative and nonoperative appendicitis treatments result in differences in risk perception. BACKGROUND: Surgeons must communicate the probability of treatment complications to patients, and how risks are communicated may impact the accuracy and variability in patient risk perceptions and ultimately their decision making. METHODS: A series of online surveys of American adults communicated the probability of complications associated with surgical or antibiotic treatment of acute appendicitis. Probability was communicated with verbal descriptors (eg, "uncommon"), point estimates (eg, "3% risk"), or risk ranges (eg, "1% to 5%"). Respondents then estimated the probability of a complication for a "typical patient with appendicitis." The Fligner-Killeen test of homogeneity of variance was used to compare the variability in respondent risk estimates based on the method of probability communication. RESULTS: Among 296 respondents, variance in probability estimates was significantly higher when verbal descriptions were used compared to point estimates ( P < 0.001) or risk ranges ( P < 0.001). Identical verbal descriptors produced meaningfully different risk estimates depending on the complication being described. For example, "common" was perceived as a 45.6% for surgical site infection but 61.7% for antibiotic-associated diarrhea. CONCLUSION: Verbal probability descriptors are associated with widely varying and inaccurate perceptions about treatment risks. Surgeons should consider alternative ways to communicate probability during informed consent and shared decision-making discussions.


Assuntos
Apendicite , Adulto , Humanos , Probabilidade , Comunicação , Consentimento Livre e Esclarecido , Inquéritos e Questionários
2.
J Surg Res ; 289: 82-89, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37086600

RESUMO

INTRODUCTION: Patients with acute uncomplicated appendicitis will be increasingly asked to choose between surgery and antibiotic management. We developed a novel decision aid for patients in the emergency department (ED) with acute appendicitis who are facing this choice. We describe the development of the decision aid and an initial feasibility study of its implementation in a busy tertiary care ED. MATERIALS AND METHODS: We conducted a prepost survey analysis comparing patients before and after standardized implementation of the decision aid. Patients were surveyed about their experience making treatment decisions after discharge from the hospital. The primary outcome measure was the total score on the decisional conflict scale (; 0-100; lower scores better). RESULTS: The study included 24 participants (12 in the predecision aid period; 12 in the post period). Only 33% of participants in each group knew antibiotics were a treatment option prior to arriving at the ED. Prior to implementing the use of decision aid, only 75% of patients reported being told antibiotics were a treatment option, while this increased to 100% after implementation of the decision aid. The mean total decisional conflict scalescores were similar in the pre and post periods (mean difference = 0.13, 95% CI: -13 - 13, P > 0.9). CONCLUSIONS: This novel appendicitis decision aid was effectively integrated into clinical practice and helped toinform patients about multiple treatment options. These data support further large-scale testing of the decision aid as part of standardized pathways for the management of patients with acute appendicitis.


Assuntos
Apendicite , Técnicas de Apoio para a Decisão , Humanos , Apendicite/diagnóstico , Apendicite/cirurgia , Apendicite/tratamento farmacológico , Estudos de Viabilidade , Participação do Paciente , Doença Aguda , Antibacterianos/uso terapêutico
3.
Neuroradiology ; 65(1): 41-54, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35876874

RESUMO

BACKGROUND: Because of the lack of global accessibility, delay, and cost-effectiveness of genetic testing, there is a clinical need for an imaging-based stratification of gliomas that can prognosticate survival and correlate with the 2021-WHO classification. METHODS: In this retrospective study, adult primary glioma patients with pre-surgery/pre-treatment MRI brain images having T2, FLAIR, T1, T1 post-contrast, DWI sequences, and survival information were included in TCIA training-dataset (n = 275) and independent validation-dataset (n = 200). A flowchart for imaging-based stratification of adult gliomas(IBGS) was created in consensus by three authors to encompass all adult glioma types. Diagnostic features used were T2-FLAIR mismatch sign, central necrosis with peripheral enhancement, diffusion restriction, and continuous cortex sign. Roman numerals (I, II, and III) denote IBGS types. Two independent teams of three and two radiologists, blinded to genetic, histology, and survival information, manually read MRI into three types based on the flowchart. Overall survival-analysis was done using age-adjusted Cox-regression analysis, which provided both hazard-ratio (HR) and area-under-curve (AUC) for each stratification system(IBGS and 2021-WHO). The sensitivity and specificity of each IBSG type were analyzed with cross-table to identify the corresponding 2021-WHO genotype. RESULTS: Imaging-based stratification was statistically significant in predicting survival in both datasets with good inter-observer agreement (age-adjusted Cox-regression, AUC > 0.5, k > 0.6, p < 0.001). IBGS type-I, type-II, and type-III gliomas had good specificity in identifying IDHmut 1p19q-codel oligodendroglioma (training - 97%, validation - 85%); IDHmut 1p19q non-codel astrocytoma (training - 80%, validation - 85.9%); and IDHwt glioblastoma (training - 76.5%, validation- 87.3%) respectively (p-value < 0.01). CONCLUSIONS: Imaging-based stratification of adult diffuse gliomas predicted patient survival and correlated well with 2021-WHO glioma classification.


Assuntos
Neoplasias Encefálicas , Glioma , Adulto , Humanos , Neoplasias Encefálicas/genética , Estudos Retrospectivos , Mutação , Glioma/genética , Imageamento por Ressonância Magnética/métodos , Organização Mundial da Saúde , Isocitrato Desidrogenase/genética
4.
J Anaesthesiol Clin Pharmacol ; 39(3): 435-443, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38025557

RESUMO

Background and Aims: Airway management in cervical spine injury patients requires manual in-line stabilization (MILS) of the neck to avoid exacerbation of cord injury, which impedes visualization of glottis during laryngoscopy. Specially designed blades such as McCoy and C-MAC D-blades can improve laryngoscopic view in such patients. This study was performed to compare the efficacy of C-MAC D-blades and the McCoy laryngoscope for oro-tracheal intubation using MILS in patients undergoing cervical spine surgery. Material and Methods: This randomized, prospective study was performed in 60 adult patients of American Society of Anesthesiologists grade I-III, either sex, 18 to 60 years of age undergoing elective cervical spine surgery. Patients were randomly categorized into two groups, group D and group M. Intubation was performed using a C-MAC D-blade videolaryngoscope in group D and a McCoy laryngoscope in group M using MILS. The intubation difficulty scale (IDS) score, laryngoscopy and intubation times, percentage of glottic opening (POGO) score, Cormack Lehane (CL) grading with and without external laryngeal pressure (ELP), need for bougie or change of blade or operator, and change in hemodynamics following intubation were recorded. Results: Group D showed lower mean IDS scores than group M (P value < 0.0001). There were statistically significant differences found in duration of laryngoscopy (group D < group M), CL grading without ELP (group D: CL-1,2a >CL-2b, 3; group M: CL-1,2a group M), need for ELP and lifting force (group D < group M), and hemodynamic responses after intubation (group D < group M). Conclusion: A C-MAC D-blade videolaryngoscope provides better and rapid visualization of glottis with less intubation difficulties than a McCoy laryngoscope during intubation using MILS in patients with cervical spine injury.

5.
J Surg Res ; 279: 540-547, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35921720

RESUMO

INTRODUCTION: Dietary interventions are increasingly being proposed as alternatives to surgery for common gastrointestinal conditions. Integrating aspects of cognitive psychology (e.g., behavioral nudges) into dietary interventions is becoming popular, but evidence is lacking on their effectiveness and unintended effects. We assessed the effects of including nudges in the development of a dietary intervention based on the Mediterranean diet. METHODS: We conducted two-arm randomized surveys of United States adults. After a validated dietary questionnaire, participants received feedback about dietary consistency with a Mediterranean diet with (A) no nudge versus (B) one of several nudges: peer comparison, positive affect induction + peer comparison, or defaults. Participants rated their negative and positive emotions, motivation for dietary change, and interest in recipes. Responses were analyzed using baseline covariate-adjusted regression. RESULTS: Among 1709 participants, 56% were men and the median age was 36 y. Nudges as a class did not significantly affect the extent of negative or positive emotions, motivation, or interest. However, specific nudges had different effects: compared to no nudge, peer comparison blunted negative emotions and increased motivation, although decreased interest in recipes, while defaults increased interest in recipes but reduced motivation. CONCLUSIONS: In this pilot, behavioral nudges as a class of strategies did not improve participants' reactions to dietary feedback nor did they promote negative reactions. However, specific nudges may be better considered separately in their effects. Future testing should explore whether specific nudges including peer comparison and defaults improve dietary intervention effectiveness, especially in people with the specific gastrointestinal conditions of interest.


Assuntos
Dieta , Motivação , Adulto , Retroalimentação , Feminino , Humanos , Masculino , Inquéritos e Questionários
6.
Pituitary ; 25(4): 602-614, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35622211

RESUMO

PURPOSE: Hypophysitis can clinically and radiologically mimic other nonfunctioning masses of the sella turcica, complicating preoperative diagnosis. While sellar masses may be treated surgically, hypophysitis is often treated medically, so differentiating between them facilitates optimal management. The objective of our study was to develop a scoring system for the preoperative diagnosis of hypophysitis. METHODS: A thorough literature review identified published hypophysitis cases, which were compared to a retrospective group of non-functioning pituitary adenomas (NFA) from our institution. A preoperative hypophysitis scoring system was developed and internally validated. RESULTS: Fifty-six pathologically confirmed hypophysitis cases were identified in the literature. After excluding individual cases with missing values, 18 hypophysitis cases were compared to an age- and sex-matched control group of 56 NFAs. Diabetes insipidus (DI) (p < 0.001), infundibular thickening (p < 0.001), absence of cavernous sinus invasion (CSI) (p < 0.001), relation to pregnancy (p = 0.002), and absence of visual symptoms (p = 0.007) were significantly associated with hypophysitis. Stepwise logistic regression identified DI and infundibular thickening as positive predictors of hypophysitis. CSI and visual symptoms were negative predictors. A 6-point hypophysitis-risk scoring system was derived: + 2 for DI, + 2 for absence of CSI, + 1 for infundibular thickening, + 1 for absence of visual symptoms. Scores ≥ 3 supported a diagnosis of hypophysitis (AUC 0.96, sensitivity 100%, specificity 75%). The scoring system identified 100% of hypophysitis cases at our institution with an estimated 24.7% false-positive rate. CONCLUSIONS: The proposed scoring system may aid preoperative diagnosis of hypophysitis, preventing unnecessary surgery in these patients.


Assuntos
Adenoma , Diabetes Insípido , Hipofisite , Neoplasias Hipofisárias , Adenoma/complicações , Humanos , Hipofisite/diagnóstico por imagem , Hipofisite/etiologia , Neoplasias Hipofisárias/diagnóstico , Estudos Retrospectivos , Sela Túrcica
7.
J Anaesthesiol Clin Pharmacol ; 38(2): 184-190, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36171917

RESUMO

Background and Aims: Several supraglottic airway devices (SGD) are available nowadays. But none has been found to be better than Proseal laryngeal mask (PLMA) in terms of oropharyngeal leak pressure (OLP). We aimed to compare OLP of newly introduced Baska® Mask with PLMA in patients undergoing elective surgical procedures under general anesthesia. Material and Methods: Totally, 80 consecutive adult patients of either sex requiring general anesthesia were randomized into two groups Group B (Baska mask, n = 40) or Group P (PLMA. n = 40). After standardized induction with propofol 2 - 2.5 mg/kg-1 and fentanyl 2 mgkg-1, and muscle relaxation with vecuronium 0.1 mgkg-1 one of the two devices was placed. OLP (primary outcome) was measured 5 minutes and 30 minutes post induction. The time needed to achieve effective airway, anatomical alignment of the device, number of attempts, leak fraction, and postoperative laryngopharyngeal morbidity were noted. Results: Both the devices could be inserted in first attempt in all the patients, but the time needed to achieve effective airway was significantly less in Group B (12.58 ± 1.81 sec vs 17.92 ± 2.45 sec, P < 0.001). The mean OLP was better in Group B at 5 min (37.6 ± 2.43 cm H2O vs 30.82 ± 3.96 cm H2O) and at 30 min (38.83 ± 1.72 cm H2O vs 30.82 ± 3.96 cm H2O; P < 0.001). Anatomical alignment of SGD with glottis (FOB grade 3 or 4 view) was significantly better in group B (34/40) as compared to group P (25/40) (p = 0.009). There was no difference in laryngopharyngeal morbidity in the two groups. Conclusion: Baska mask provided higher OLP, better alignment to the glottis and faster placement time as compared to PLMA.

8.
Pituitary ; 23(5): 582-594, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32602066

RESUMO

PURPOSE: Biochemical control is the main determinant of survival, clinical manifestations and comorbidities in acromegaly. Transsphenoidal selective adenomectomy (TSA) is the initial treatment of choice with reported biochemical remission rates varying between 32 and 85%. Understanding the limiting factors is essential for identification of patients who require medical treatment. METHODS: We reviewed the English literature published in Medline/Pubmed until Dec 31, 2019 to identify eligible studies that described outcomes of TSA as primary therapy and performed analyses to determine the main predictors of remission. RESULTS: Most publications reported single-institution, retrospective studies. The following preoperative parameters were consistently associated with lower remission rates: cavernous sinus invasion by imaging, larger tumor size and higher GH levels. Young age and preoperative IGF-1 levels were predictive in some studies. When controlled for covariates, the best single preoperative predictor was cavernous sinus invasion, followed by preoperative GH levels. Conversely, low GH level in the first few days postoperatively was a robust predictor of durable remission. The influence of tumor histology (sparsely granular pattern, co-expression of prolactin and proliferation markers) on surgical remission remains to be established. Few studies developed predictive models that yielded much higher predictive values than individual parameters. CONCLUSION: Surgical outcome prognostication systems could be further generated by machine learning algorithms in order to support development and implementation of personalized care in patients with acromegaly.


Assuntos
Acromegalia/patologia , Acromegalia/cirurgia , Procedimentos Neurocirúrgicos/métodos , Acromegalia/sangue , Biomarcadores Tumorais/sangue , Hormônio do Crescimento Humano/sangue , Humanos , Prognóstico , Resultado do Tratamento
9.
Am J Transplant ; 19(5): 1452-1463, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30501008

RESUMO

The pathological diagnosis of borderline rejection (BL-R) denotes possible T cell-mediated rejection (TCMR), but its clinical significance is uncertain. This single-center, cross-sectional cohort study compared the functional and histological outcomes of consecutive BL-R diagnoses (n = 146) against normal controls (n = 826) and acute TCMR (n = 55) from 551 renal transplant recipients. BL-R was associated with the following: contemporaneous renal dysfunction, acute tubular necrosis, and chronic tubular atrophy (P < .001); progressive tubular injury with fibrosis by longitudinal sequential histology (45.3% at 1 year); increased subsequent acute rejection (39.4%), allograft failure (P < .001), and patient mortality (P = .007). BL-R detected by biopsy indicated for impaired function was followed by suboptimal functional recovery (46.3%), persistent inflammation (27.2%), and acute rejection episodes (50.0%) despite antirejection treatment in 83.3%. By 1 year after BL-R, the incidence of new-onset microvascular inflammation (9.3%), C4d staining (22.3%), transplant glomerulopathy (13.3%), and de novo donor-specific antibodies (31.5%) exceeded normal controls (P < .05-.001). BL-R inflammation in protocol biopsy persisted in 28.0% and progressed to acute rejection in 32.6%; however, it resolved in 61.6% of the untreated cases. In summary, BL-R is a heterogeneous diagnostic grouping, ranging from mild inconsequential inflammation to clinically significant TCMR, which is capable of immune-mediated tubular injury resulting in inferior functional, immunological, and histological consequences.


Assuntos
Rejeição de Enxerto/patologia , Sobrevivência de Enxerto/imunologia , Isoanticorpos/imunologia , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias , Linfócitos T/imunologia , Complemento C4b/imunologia , Feminino , Seguimentos , Taxa de Filtração Glomerular , Rejeição de Enxerto/etiologia , Humanos , Falência Renal Crônica/patologia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Doadores de Tecidos , Transplantados , Transplante Homólogo
10.
Behav Pharmacol ; 30(8): 642-652, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31625975

RESUMO

Neurodegenerative disorders have been considered as a growing health concern for decades. Increasing risk of neurodegenerative disorders creates a socioeconomic burden to both patients and care givers. Mitochondria are organelle that are involved in both neuroinflammation and neurodegeneration. There are few reports on the effect of mitochondrial metabolism on the progress of neurodegeneration and neuroinflammation. Therefore, the present review summarizes the potential contribution of mitochondrial metabolic pathways in the pathogenesis of neuroinflammation and neurodegeneration. Mitochondrial pyruvate metabolism plays a critical role in the pathogenesis of neurodegenerative disorders such as Parkinson's disease and Alzheimer's disease. However, there its potential contribution in other neurodegenerative disorders is as yet unproven. The mitochondrial pyruvate carrier and pyruvate dehydrogenase can modulate mitochondrial pyruvate metabolism to attenuate neuroinflammation and neurodegeneration. Further, it has been observed that the mitochondrial citric acid cycle can regulate the pathogenesis of neuroinflammation and neurodegeneration. Additional research should be undertaken to target tricarboxylic acid cycle enzymes to minimize the progress of neuroinflammation and neurodegeneration. It has also been observed that the mitochondrial urea cycle can potentially contribute to the progression of neurodegenerative disorders. Therefore, targeting this pathway may control the mitochondrial dysfunction-induced neuroinflammation and neurodegeneration. Furthermore, the mitochondrial malate-aspartate shuttle could be another target to control mitochondrial dysfunction-induced neuroinflammation and neurodegeneration in neurodegenerative disorders.


Assuntos
Mitocôndrias/patologia , Doenças Neurodegenerativas/patologia , Neuroimunomodulação/fisiologia , Doença de Alzheimer/metabolismo , Animais , Ciclo do Ácido Cítrico/fisiologia , Humanos , Mitocôndrias/metabolismo , Doenças Neurodegenerativas/metabolismo , Doença de Parkinson/metabolismo , Ácido Pirúvico/metabolismo
11.
Endocr Pract ; 25(9): 943-950, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31170367

RESUMO

Objective: Abnormalities of water and sodium balance, including diabetes insipidus and the syndrome of inappropriate antidiuretic hormone (SIADH), are common complications of transsphenoidal surgery. Postoperative practice patterns vary among clinicians, and no consensus guidelines exist to direct their monitoring and management. We aimed to identify and compare practice patterns regarding the evaluation and management to these postoperative complications. Methods: A questionnaire was utilized to capture demographic data and practice habits in the postoperative setting. Respondents were members of the Pituitary Society, an international organization comprised of clinicians and researchers dedicated to the study of pituitary disease. Results: Eighty-six respondents completed at least part of the survey. The geographic distribution of respondents was roughly even between American and non-American practitioners. The majority of respondents practiced at academic institutions (67.4%), worked in multidisciplinary teams (88.4%), and possessed significantly greater than 10 years of clinical experience (71%). Compared to non-American practitioners, American practitioners described a shorter length of stay postoperatively (P<.001) and prescribed more restrictive volume recommendations for postoperative SIADH (P = .0035). Early career clinicians (less than 10 years in practice) checked first postoperative sodium level earlier than later career clinicians (P = .010). Conclusion: Water and sodium dysregulation are common following transsphenoidal surgery, but their management is not well-standardized in clinical practice. We created a questionnaire to define and compare practice patterns. Most respondents practice in academic settings in multidisciplinary teams. The length of clinical experience did not significantly impact practice habits. Practice location influenced length of stay postoperatively and fluid restriction in SIADH. Abbreviations: AVP = arginine vasopressin; DI = diabetes insipidus; LOS = length of stay; SIADH = syndrome of inappropriate antidiuretic hormone.


Assuntos
Doenças da Hipófise , Humanos , Doenças da Hipófise/cirurgia , Hipófise , Complicações Pós-Operatórias , Padrões de Prática Médica
13.
Community Ment Health J ; 54(2): 218-223, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28456858

RESUMO

To study the association of impulsivity, high-risk behaviours and incidence of HIV infection in patients with alcohol dependence and bipolar mania. This was a cross-sectional hospital-based pilot study and the sample consisted of male patients divided into three groups: 25 patients with alcohol dependence and 25 with bipolar mania as per ICD-10 Diagnostic Criteria for Research and 25 normal controls. Severity of Alcohol Dependence Questionnaire (SADQ) and Young Mania Rating Scale (YMRS) were administered on alcohol dependent and bipolar patients, respectively. All three groups were rated on Barrett's Impulsivity Scale (BIS) and HIV Risk-taking Behaviour Scale (HRBS). None of the patients tested positive for either HIV 1 or 2. BIS motor impulsivity, BIS total score and HRBS total score were significantly higher in alcohol dependent patients as compared to bipolar mania patients. In the Alcohol dependent group, BIS score significantly correlated with education years, age of onset of alcohol use and SADQ, whereas, HRBS total score significantly correlated with SADQ scores. In the bipolar mania group, BIS significantly correlated with YMRS, and total number of episodes, whereas, there was no significant correlation of HRBS total score with any clinical variable. The findings of this pilot study underscore the link between alcohol use disorder and the impulsive behaviours that can lead to HIV infection, and highlight that those risks are higher for individuals with alcohol dependency than for individuals with bipolar disorder.


Assuntos
Alcoolismo/psicologia , Transtorno Bipolar/psicologia , Comportamento Impulsivo , Assunção de Riscos , Sexo sem Proteção/psicologia , Adolescente , Adulto , Alcoolismo/complicações , Transtorno Bipolar/complicações , Estudos Transversais , Infecções por HIV/epidemiologia , Infecções por HIV/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Escalas de Graduação Psiquiátrica , Testes Psicológicos , Inquéritos e Questionários , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
16.
Endocr Pract ; 23(4): 451-457, 2017 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-28095037

RESUMO

OBJECTIVE: Encapsulated non-invasive follicular variant papillary thyroid cancer (ENIFVPTC) has recently been retermed noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This designation specifically omits the word "cancer" to encourage conservative treatment since patients with NIFTP tumors have been shown to derive no benefit from completion thyroidectomy or adjuvant radio-active iodine (RAI) therapy. METHODS: This was a retrospective study of consecutive cases of tumors from 2007 to 2015 that met pathologic criteria for NIFTP. The conservative management (CM) group included patients managed with lobectomy alone or appropriately indicated total thyroidectomy. Those included in the aggressive management (AM) group received either completion thyroidectomy or RAI or both. RESULTS: From 100 consecutive cases of ENIFVPTC reviewed, 40 NIFTP were included for the final analysis. Of these, 10 (27%) patients treated with initial lobectomy received completion thyroidectomy and 6 of 40 (16%) also received postsurgical adjuvant RAI. The mean per-patient cost of care in the AM group was $17,629 ± 2,865, nearly twice the $8,637 ± 309 costs in the CM group, and was largely driven by the cost of completion thyroidectomy and RAI. CONCLUSION: The term NIFTP has been recently promulgated to identify a type of thyroid neoplasm, formerly identified as a low-grade cancer, for which initial surgery represents adequate treatment. We believe that since the new NIFTP nomenclature intentionally omits the word "cancer," the clinical indolence of these tumors will be better appreciated, and cost savings will result from more conservative and appropriate clinical management. ABBREVIATIONS: AM = aggressive management CM = conservative management ENIFVPTC = encapsulated noninvasive form of FVPTC FVPTC = follicular variant of papillary thyroid carcinoma NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features PTC = papillary thyroid carcinoma PTMC = papillary thyroid microcarcinoma RAI = radio-active iodine US = ultrasound.


Assuntos
Carcinoma Papilar, Variante Folicular , Neoplasias da Glândula Tireoide , Adulto , Carcinoma Papilar, Variante Folicular/economia , Carcinoma Papilar, Variante Folicular/patologia , Carcinoma Papilar, Variante Folicular/radioterapia , Carcinoma Papilar, Variante Folicular/cirurgia , Núcleo Celular/patologia , Feminino , Custos de Cuidados de Saúde , Recursos em Saúde/estatística & dados numéricos , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Tratamentos com Preservação do Órgão/economia , Tratamentos com Preservação do Órgão/métodos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/economia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Carga Tumoral
18.
BMC Med Inform Decis Mak ; 16(1): 153, 2016 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-27905926

RESUMO

BACKGROUND: Prospect theory suggests that when faced with an uncertain outcome, people display loss aversion by preferring to risk a greater loss rather than incurring certain, lesser cost. Providing probability information improves decision making towards the economically optimal choice in these situations. Clinicians frequently make decisions when the outcome is uncertain, and loss aversion may influence choices. This study explores the extent to which prospect theory, loss aversion, and probability information in a non-clinical domain explains clinical decision making under uncertainty. METHODS: Four hundred sixty two participants (n = 117 non-medical undergraduates, n = 113 medical students, n = 117 resident trainees, and n = 115 medical/surgical faculty) completed a three-part online task. First, participants completed an iced-road salting task using temperature forecasts with or without explicit probability information. Second, participants chose between less or more risk-averse ("defensive medicine") decisions in standardized scenarios. Last, participants chose between recommending therapy with certain outcomes or risking additional years gained or lost. RESULTS: In the road salting task, the mean expected value for decisions made by clinicians was better than for non-clinicians(-$1,022 vs -$1,061; <0.001). Probability information improved decision making for all participants, but non-clinicians improved more (mean improvement of $64 versus $33; p = 0.027). Mean defensive decisions decreased across training level (medical students 2.1 ± 0.9, residents 1.6 ± 0.8, faculty1.6 ± 1.1; p-trend < 0.001) and prospect-theory-concordant decisions increased (25.4%, 33.9%, and 40.7%;p-trend = 0.016). There was no relationship identified between road salting choices with defensive medicine and prospect-theory-concordant decisions. CONCLUSIONS: All participants made more economically-rational decisions when provided explicit probability information in a non-clinical domain. However, choices in the non-clinical domain were not related to prospect-theory concordant decision making and risk aversion tendencies in the clinical domain. Recognizing this discordance may be important when applying prospect theory to interventions aimed at improving clinical care.


Assuntos
Tomada de Decisão Clínica , Tomada de Decisões , Médicos , Estudantes , Incerteza , Adolescente , Adulto , Idoso , Docentes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudantes de Medicina , Universidades , Adulto Jovem
19.
J Obstet Gynaecol Res ; 41(11): 1820-2, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26178425

RESUMO

Twin ectopic pregnancy is a rare occurrence, with an estimated incidence of 1 in 20 000 spontaneous pregnancies. We describe a case of unilateral twin ectopic pregnancy in which the gravid fallopian tube showed no signs of tubal rupture despite marked tubal distension. A 25-year-old woman presented with clinical features suggestive of large right-sided tubal ectopic pregnancy. Serum ß-human chorionic gonadotropin was 10 800 IU/mL. Laparotomy revealed markedly distended right fallopian tube. There was no hemoperitoneum. The tube contained twin gestational sacs. The crown-rump length of the embryos was 2 cm. The ectopic gestation was thus unique, in that despite marked tubal distension, the trophoblastic invasion was not significant to cause tubal rupture. There may be a role for medical management based on individual gestational sac size in selected cases of twin tubal pregnancy in which there is no evidence of hemoperitoneum.


Assuntos
Gravidez Tubária/diagnóstico , Gravidez de Gêmeos , Ultrassonografia Pré-Natal , Adulto , Gonadotropina Coriônica Humana Subunidade beta/urina , Feminino , Humanos , Laparotomia , Gravidez , Gravidez Tubária/diagnóstico por imagem , Gravidez Tubária/cirurgia , Gravidez Tubária/urina , Resultado do Tratamento
20.
Nano Lett ; 14(2): 626-33, 2014 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-24382089

RESUMO

The III-V semiconductors such as In x Ga 1-x As (x = 0.53-0.70) have attracted significant interest in the context of low power digital complementary metal-oxide-semiconductor (CMOS) technology due to their superior transport properties. However, top-down patterning of III-V semiconductor thin films into strongly confined quasi-one-dimensional (1D) nanowire geometries can potentially degrade the transport properties. To date, few reports exist regarding transport measurement in multigate nanowire structures. In this work, we report a novel methodology for characterizing electron transport in III-V multigate nanowire field effect transistors (NWFETs). We demonstrate multigate NWFETs integrated with probe electrodes in Hall Bridge geometry to enable four-point measurements of both longitudinal and transverse resistance. This allows for the first time accurate extraction of Hall mobility and its dependence on carrier concentration in III-V NWFETs. Furthermore, it is shown that by implementing parallel arrays of nanowires, it is possible to enhance the signal-to-noise ratio of the measurement, enabling more reliable measurement of Hall voltage (carrier concentration) and, hence, mobility. We characterize the mobility for various nanowire widths down to 40 nm and observe a monotonic reduction in mobility compared to planar devices. Despite this reduction, III-V NWFET mobility is shown to outperform state-of-the-art strained silicon NWFETs. Finally, we demonstrate evidence of room -temperature ballistic transport, a desirable property in the context of short channel transistors, in strongly confined III-V nanowire junctions using magneto-transport measurements in a nanoscale Hall-cross structure.

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